Healthcare Provider Details

I. General information

NPI: 1730611914
Provider Name (Legal Business Name): ISIDRO ENRIQUE DURAZO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 03/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5284 ADOLFO RD STE 100
CAMARILLO CA
93012-6790
US

IV. Provider business mailing address

4311 BERKSHIRE CT
OXNARD CA
93033-6717
US

V. Phone/Fax

Practice location:
  • Phone: 805-289-0120
  • Fax:
Mailing address:
  • Phone: 805-827-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: