Healthcare Provider Details

I. General information

NPI: 1003739129
Provider Name (Legal Business Name): MR. MIGUEL LORENZO DUQUE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MIGUEL LORENZO DUQUE PADILLA

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2743 HIGHLAND AVE
NATIONAL CITY CA
91950-7410
US

IV. Provider business mailing address

637 3RD AVE
CHULA VISTA CA
91910-5707
US

V. Phone/Fax

Practice location:
  • Phone: 844-200-2426
  • Fax:
Mailing address:
  • Phone: 844-200-2426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPCC23109
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: