Healthcare Provider Details

I. General information

NPI: 1972964252
Provider Name (Legal Business Name): DARRON JACKSON DURGIN REGISTERED NURSE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2016
Last Update Date: 03/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1727 S LATUS PL
ANAHEIM CA
92804-6432
US

IV. Provider business mailing address

1727 S LATUS PL
ANAHEIM CA
92804-6432
US

V. Phone/Fax

Practice location:
  • Phone: 714-935-8158
  • Fax: 714-935-6020
Mailing address:
  • Phone: 714-935-8158
  • Fax: 714-935-6020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number571801
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License Number571801
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: