MEDICARE: DUANE EMIL MCWAINE MD

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	2084P0800X	Psychiatry Physician	G056319	CA

General Provider Information

NPI Number	:	1629112123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DUANE EMIL MCWAINE MD

Provider Business Mailing Address
First Line	:	800 S VICTORIA AVE, L4615
Second Line	:	VCHCA - PHYSICIAN SERVICES
City	:	VENTURA
State	:	CA
Zip	:	93009-0003
Country	:	US
Telephone Number	:	805-677-5181
Fax Number	:	805-677-5304

Provider Business Practice Location Address
First Line	:	1314 WESTWOOD BLVD
Second Line	:	SUITE 101D
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-4902
Country	:	US
Telephone Number	:	310-474-5055
Fax Number	:

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

Provider Enumeration Date	:	02/16/2007
Last Update Date	:	01/16/2020

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