Healthcare Provider Details

I. General information

NPI: 1043137805
Provider Name (Legal Business Name): DUALITY WITHIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11189 SORRENTO VALLEY RD
SAN DIEGO CA
92121-1341
US

IV. Provider business mailing address

2192 CAMINITO RINALDO UNIT 121
CHULA VISTA CA
91915-4189
US

V. Phone/Fax

Practice location:
  • Phone: 619-438-0790
  • Fax:
Mailing address:
  • Phone: 334-498-0761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MIRIAH M BOZEMAN
Title or Position: LCSW
Credential: LCSW
Phone: 334-498-0761