Healthcare Provider Details

I. General information

NPI: 1629238910
Provider Name (Legal Business Name): MS. NELLIE DURAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 06/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 G ST SUITE 102
FRESNO CA
93706-1643
US

IV. Provider business mailing address

1206 G ST SUITE 102
FRESNO CA
93706-1643
US

V. Phone/Fax

Practice location:
  • Phone: 559-459-0334
  • Fax: 559-459-0339
Mailing address:
  • Phone: 559-459-0334
  • Fax: 559-459-0339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: