Healthcare Provider Details

I. General information

NPI: 1871425736
Provider Name (Legal Business Name): MIA MARIE DUARTE LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 BREEDERS CUP PL
NORCO CA
92860-5127
US

IV. Provider business mailing address

110 BREEDERS CUP PL
NORCO CA
92860-5127
US

V. Phone/Fax

Practice location:
  • Phone: 951-847-2331
  • Fax:
Mailing address:
  • Phone: 951-847-2331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberVN760528
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: