MEDICARE: EDMAR ALBERTO DUENAS PTA

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	2081S0010X	Sports Medicine (Physical Medicine & Rehabilitation) Physician	NA	CA

General Provider Information

NPI Number	:	1609391366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDMAR ALBERTO DUENAS PTA

Provider Business Mailing Address
First Line	:	2318 FRANZEN AVE APT A
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92705-1756
Country	:	US
Telephone Number	:	714-317-0893
Fax Number	:

Provider Business Practice Location Address
First Line	:	2318 FRANZEN AVE APT A
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92705-1756
Country	:	US
Telephone Number	:	714-317-0893
Fax Number	:

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

Provider Enumeration Date	:	08/03/2017
Last Update Date	:	07/21/2022

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