MEDICARE: TITO DURAN

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	315P00000X	Intellectual Disabilities Intermediate Care Facility	960000990	CA

General Provider Information

NPI Number	:	1831072693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TITO DURAN

Provider Business Mailing Address
First Line	:	1309 W 159TH ST
Second Line	:
City	:	GARDENA
State	:	CA
Zip	:	90247-4323
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1309 W 159TH ST
Second Line	:
City	:	GARDENA
State	:	CA
Zip	:	90247-4323
Country	:	US
Telephone Number	:	310-217-0437
Fax Number	:	424-378-6334

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

Provider Enumeration Date	:	07/29/2025
Last Update Date	:	07/29/2025

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Directions to “ TITO DURAN ” Practice Location

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