Healthcare Provider Details

I. General information

NPI: 1780237420
Provider Name (Legal Business Name): REBECCA ANNE DURAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2019
Last Update Date: 07/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7339 N 1ST ST STE 110
FRESNO CA
93720-2954
US

IV. Provider business mailing address

PO BOX 4206
VISALIA CA
93278-4206
US

V. Phone/Fax

Practice location:
  • Phone: 916-879-7862
  • Fax:
Mailing address:
  • Phone: 559-280-1645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: