Healthcare Provider Details

I. General information

NPI: 1073429924
Provider Name (Legal Business Name): SELENA M DURAN CPSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

771 W BLAINE ST STE D
RIVERSIDE CA
92507-3940
US

IV. Provider business mailing address

13247 FOOTHILL BLVD
RANCHO CUCAMONGA CA
91739-9677
US

V. Phone/Fax

Practice location:
  • Phone: 951-955-2333
  • Fax:
Mailing address:
  • Phone: 919-502-9633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-FWEPBA
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: