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General NPI Number Information
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NPI Number | 1083731533
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Entity Type | Individual
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Provider Name | MARLON MANRIQUE DUARTE
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Gender | Male
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1000 VETERAN AVE
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City | LOS ANGELES
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State | CA
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Zip | 90095-7142
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Country | US
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Telephone | 310-206-2981
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Fax |
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Provider Business Mailing Address
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Address Line | 15928 LONDELIUS ST
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City | NORTH HILLS
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State | CA
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Zip | 91343-4842
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Country | US
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Telephone | 818-399-4165
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State | CA
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