Healthcare Provider Details

I. General information

NPI: 1376194605
Provider Name (Legal Business Name): REBECCA DURAN NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2019
Last Update Date: 03/06/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 TERRACINA BLVD STE 202
REDLANDS CA
92373-4870
US

IV. Provider business mailing address

255 TERRACINA BLVD STE 202
REDLANDS CA
92373-4870
US

V. Phone/Fax

Practice location:
  • Phone: 909-748-6065
  • Fax: 909-748-6095
Mailing address:
  • Phone: 909-748-6065
  • Fax: 909-748-6095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95012908
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: