Basic Information
| Provider Information | |||||||||
| NPI: | 1164688438 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DURAN | ||||||||
| FirstName: | TAMI | ||||||||
| MiddleName: | KRISTINA | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LPT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CESSWA | ||||||||
| OtherFirstName: | TAMI | ||||||||
| OtherMiddleName: | KRISTINA | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | LPT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1435 STANLEY AVE | ||||||||
| Address2: | APT 117 | ||||||||
| City: | GLENDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 912063984 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8184845473 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 223 E ROWLAND ST | ||||||||
| Address2: | |||||||||
| City: | COVINA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917233147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6263323145 | ||||||||
| FaxNumber: | 6269744164 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2008 | ||||||||
| LastUpdateDate: | 06/05/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 374700000X | PT 30023 | CA | N | Nursing Service Related Providers | Technician | 167G00000X | PT30023 | CA | Y | Nursing Service Providers | Licensed Psychiatric Technician |
No ID Information.