Healthcare Provider Details

I. General information

NPI: 1568366565
Provider Name (Legal Business Name): MRS. IVONNE DURAZO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 E WALNUT ST
PASADENA CA
91101-1517
US

IV. Provider business mailing address

933 N UNRUH AVE
LA PUENTE CA
91744-2038
US

V. Phone/Fax

Practice location:
  • Phone: 626-320-8151
  • Fax:
Mailing address:
  • Phone: 626-712-4357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: