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NPI Code Detail

MEDICARE: JENNIFER KRYSTAL DURAZO

MEDICARE: JENNIFER KRYSTAL DURAZO
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
1225400000XRehabilitation Practitioner

General Provider Information

NPI Number : 1609420728
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER KRYSTAL DURAZO
Provider Business Mailing Address
First Line : 97 E BROKAW RD STE 150
Second Line :
City : SAN JOSE
State : CA
Zip : 95112-4221
Country : US
Telephone Number : 209-465-1080
Fax Number : 209-465-2709
Provider Business Practice Location Address
First Line : 97 E BROKAW RD STE 150
Second Line :
City : SAN JOSE
State : CA
Zip : 95112-4221
Country : US
Telephone Number : 209-465-1080
Fax Number : 209-465-2709
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2019
Last Update Date : 08/20/2025

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Directions to “ JENNIFER KRYSTAL DURAZO ” Practice Location

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