Healthcare Provider Details

I. General information

NPI: 1780180315
Provider Name (Legal Business Name): TEODOR DURO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 PENNSYLVANIA AVE STE 110
FAIRFIELD CA
94533-3550
US

IV. Provider business mailing address

4500 BUSINESS CENTER DR
FAIRFIELD CA
94534-6888
US

V. Phone/Fax

Practice location:
  • Phone: 707-646-4114
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberA164053
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD2021-0170
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: