Healthcare Provider Details

I. General information

NPI: 1316624679
Provider Name (Legal Business Name): LEILA DURANT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2023
Last Update Date: 05/09/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 LANGFORD LAKE RD A
FT. IRWIN CA
92310
US

IV. Provider business mailing address

PO BOX 1407
HELENDALE CA
92342-1407
US

V. Phone/Fax

Practice location:
  • Phone: 760-590-8561
  • Fax:
Mailing address:
  • Phone: 760-590-8561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: