Healthcare Provider Details

I. General information

NPI: 1003690934
Provider Name (Legal Business Name): MANDEE ASHLEIGH DURAN MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2023
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11601 S WESTERN AVE
LOS ANGELES CA
90047-5006
US

IV. Provider business mailing address

11601 S WESTERN AVE
LOS ANGELES CA
90047-5006
US

V. Phone/Fax

Practice location:
  • Phone: 323-240-5000
  • Fax:
Mailing address:
  • Phone: 323-240-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number150747
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: