Healthcare Provider Details

I. General information

NPI: 1992494405
Provider Name (Legal Business Name): NANCY GUADALUPE DURON ASCW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2023
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 5TH AVE
UPLAND CA
91786-4839
US

IV. Provider business mailing address

1752 ELWOOD ST
POMONA CA
91768-1208
US

V. Phone/Fax

Practice location:
  • Phone: 909-949-6526
  • Fax:
Mailing address:
  • Phone: 909-436-6592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number90383
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: