Healthcare Provider Details

I. General information

NPI: 1407273535
Provider Name (Legal Business Name): PAUL DUARTE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2014
Last Update Date: 03/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2309 ROBLE AVE
MODESTO CA
95354-1807
US

IV. Provider business mailing address

2309 ROBLE AVE
MODESTO CA
95354-1807
US

V. Phone/Fax

Practice location:
  • Phone: 209-535-5692
  • Fax:
Mailing address:
  • Phone: 209-535-5692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberAT5763
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: