Healthcare Provider Details

I. General information

NPI: 1700702883
Provider Name (Legal Business Name): JOE A DURBIN SUDRC I #25533
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3860 HELIX ST APT 34
SPRING VALLEY CA
91977-2138
US

IV. Provider business mailing address

3860 HELIX ST APT 34
SPRING VALLEY CA
91977-2138
US

V. Phone/Fax

Practice location:
  • Phone: 701-713-5398
  • Fax:
Mailing address:
  • Phone: 701-713-5398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number25533
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: