Healthcare Provider Details

I. General information

NPI: 1962528687
Provider Name (Legal Business Name): VIVIAN DURAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 N HUDSON AVE
PASADENA CA
91101-1808
US

IV. Provider business mailing address

7460 ONYX AVE
RANCHO CUCAMONGA CA
91730-1328
US

V. Phone/Fax

Practice location:
  • Phone: 626-795-8471
  • Fax:
Mailing address:
  • Phone: 909-466-7299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: