MEDICARE: BENJAMIN DUARTE

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
1	171M00000X	Case Manager/Care Coordinator
2	103K00000X	Behavior Analyst	1-23-65442	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	$$$$$$$$$	OTHER	CA	NA

General Provider Information

NPI Number	:	1417526583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN DUARTE

Provider Business Mailing Address
First Line	:	5015 EAGLE ROCK BLVD STE 208
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90041-2087
Country	:	US
Telephone Number	:	323-312-5454
Fax Number	:

Provider Business Practice Location Address
First Line	:	5015 EAGLE ROCK BLVD STE 208
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90041-2087
Country	:	US
Telephone Number	:	323-312-5454
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2021
Last Update Date	:	05/23/2023

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Directions to “ BENJAMIN DUARTE ” Practice Location

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