=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881969087
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YOLANDA DUQUE OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2012
-----------------------------------------------------
Last Update Date | 03/20/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 330 GOLDEN SHR SUITE 250
-----------------------------------------------------
City | LONG BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90802-4246
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-256-7540
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 156 CASUDA CANYON DR
-----------------------------------------------------
City | MONTEREY PARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91754-2235
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-300-5854
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 925
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------