Healthcare Provider Details

I. General information

NPI: 1376406033
Provider Name (Legal Business Name): MILDRED DURANO BANZON CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4929 VAN NUYS BLVD STE 403
SHERMAN OAKS CA
91403-1702
US

IV. Provider business mailing address

1480 VINE ST APT 603
LOS ANGELES CA
90028-8160
US

V. Phone/Fax

Practice location:
  • Phone: 818-981-7111
  • Fax:
Mailing address:
  • Phone: 818-339-3595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1154917
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: