Healthcare Provider Details

I. General information

NPI: 1265249759
Provider Name (Legal Business Name): YADIRA R. DURAN BADWAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2024
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3602 INLAND EMPIRE BLVD STE C315
ONTARIO CA
91764-4986
US

IV. Provider business mailing address

3602 INLAND EMPIRE BLVD STE C315
ONTARIO CA
91764-4986
US

V. Phone/Fax

Practice location:
  • Phone: 909-743-5226
  • Fax: 909-743-5227
Mailing address:
  • Phone: 909-743-5226
  • Fax: 909-743-5227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: