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General NPI Number Information
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NPI Number | 1902299894
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Entity Type | Individual
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Provider Name | LUPE DURAN-EASON
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Gender | Female
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Dates
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Enumeration Date | 03/17/2015
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Last Update Date | 05/23/2024
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Provider Practice Location Address
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Address Line | 45550 GRACE ST
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City | INDIO
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State | CA
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Zip | 92201-4610
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Country | US
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Telephone | 760-342-1233
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Fax |
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Provider Business Mailing Address
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Address Line | 52610 EISENHOWER DRIVE
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City | LA QUINTA
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State | CA
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Zip | 92253
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Country | US
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Telephone | 760-902-3262
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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