MEDICARE: RAYMOND 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	164X00000X	Licensed Vocational Nurse	267364	CA

General Provider Information

NPI Number	:	1659783900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAYMOND DUARTE

Provider Business Mailing Address
First Line	:	3553 ATLANTIC AVE
Second Line	:	# A
City	:	LONG BEACH
State	:	CA
Zip	:	90807-5606
Country	:	US
Telephone Number	:	562-427-5577
Fax Number	:	562-427-1807

Provider Business Practice Location Address
First Line	:	3553 ATLANTIC AVE
Second Line	:	# A
City	:	LONG BEACH
State	:	CA
Zip	:	90807-5606
Country	:	US
Telephone Number	:	562-427-5577
Fax Number	:	562-427-1807

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

Provider Enumeration Date	:	05/21/2014
Last Update Date	:	05/21/2014

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Directions to “ RAYMOND DUARTE ” Practice Location

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