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NPI Code Detail

MEDICARE: MILDRED DURANO BANZON CNA

MEDICARE: MILDRED DURANO BANZON CNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility1154917CA

General Provider Information

NPI Number : 1376406033
Entity Type Code : Individual
Provider Name (Legal Business Name) : MILDRED DURANO BANZON CNA
Provider Business Mailing Address
First Line : 1480 VINE ST APT 603
Second Line :
City : LOS ANGELES
State : CA
Zip : 90028-8160
Country : US
Telephone Number : 818-339-3595
Fax Number :
Provider Business Practice Location Address
First Line : 4929 VAN NUYS BLVD STE 403
Second Line :
City : SHERMAN OAKS
State : CA
Zip : 91403-1702
Country : US
Telephone Number : 818-981-7111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/08/2025
Last Update Date : 12/08/2025

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