=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871749085
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANETTE MICHELLE DURAZO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/07/2008
-----------------------------------------------------
Last Update Date | 08/12/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2695 S 4TH ST BLDG E
-----------------------------------------------------
City | EL CENTRO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92243-6012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-768-3888
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 846 WOODWARD AVE APT 6
-----------------------------------------------------
City | EL CENTRO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92243-2057
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-482-0862
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225C00000X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------