Healthcare Provider Details

I. General information

NPI: 1801775002
Provider Name (Legal Business Name): TINA D DUFF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TINA DUFF

II. Dates (important events)

Enumeration Date: 09/01/2025
Last Update Date: 09/01/2025
Certification Date: 09/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14012 S KALSMAN AVE
COMPTON CA
90222-3712
US

IV. Provider business mailing address

3230 W 43RD PL
LOS ANGELES CA
90008-5254
US

V. Phone/Fax

Practice location:
  • Phone: 323-239-7487
  • Fax:
Mailing address:
  • Phone: 323-239-7487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number198320293
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: