Healthcare Provider Details

I. General information

NPI: 1437679545
Provider Name (Legal Business Name): DELYLA BONNIE JESSIE DURAZO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 07/22/2022
Certification Date: 07/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3628 STOCKDALE HWY
BAKERSFIELD CA
93309-2153
US

IV. Provider business mailing address

3628 STOCKDALE HWY
BAKERSFIELD CA
93309-2153
US

V. Phone/Fax

Practice location:
  • Phone: 661-868-6140
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: