Healthcare Provider Details

I. General information

NPI: 1962056457
Provider Name (Legal Business Name): ALEJANDRO SAUL DURAN OT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ALEXANDER RAUL OSES

II. Dates (important events)

Enumeration Date: 08/01/2019
Last Update Date: 08/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 MUIR RD
MARTINEZ CA
94553-4668
US

IV. Provider business mailing address

6828 HAYWOOD ST
TUJUNGA CA
91042-2850
US

V. Phone/Fax

Practice location:
  • Phone: 925-372-2000
  • Fax:
Mailing address:
  • Phone: 323-868-7612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number17174
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: