Healthcare Provider Details

I. General information

NPI: 1649566118
Provider Name (Legal Business Name): NOEMI DUARTE CCAPP-III
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2011
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8760 CUYAMACA ST STE 100
SANTEE CA
92071-4256
US

IV. Provider business mailing address

73 N 2ND AVE STE B
CHULA VISTA CA
91910-1124
US

V. Phone/Fax

Practice location:
  • Phone: 619-383-6868
  • Fax: 619-330-2760
Mailing address:
  • Phone: 619-426-4801
  • Fax: 619-426-0034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License NumberBII00421020
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: