Healthcare Provider Details

I. General information

NPI: 1982255147
Provider Name (Legal Business Name): CHYNNA LEAMARIE DURAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2019
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 E HACKETT RD
MODESTO CA
95358-9800
US

IV. Provider business mailing address

251 E HACKETT RD
MODESTO CA
95358-9800
US

V. Phone/Fax

Practice location:
  • Phone: 209-588-2352
  • Fax:
Mailing address:
  • Phone: 209-558-3647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: