=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073429924
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SELENA M DURAN CPSS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/20/2026
-----------------------------------------------------
Last Update Date | 08/20/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 771 W BLAINE ST STE D
-----------------------------------------------------
City | RIVERSIDE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92507-3940
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-955-2333
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13247 FOOTHILL BLVD
-----------------------------------------------------
City | RANCHO CUCAMONGA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91739-9677
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-502-9633
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 175T00000X
-----------------------------------------------------
Taxonomy Name | Peer Specialist
-----------------------------------------------------
License Number | MPSS-FWEPBA
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------