Provider Demographics
NPI:1154788404
Name:DURAN, JUAN F (PT)
Entity type:Individual
Prefix:MR
First Name:JUAN
Middle Name:F
Last Name:DURAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:JUAN
Other - Middle Name:FEDERICO
Other - Last Name:DURAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHYSICAL THERAPIST
Mailing Address - Street 1:650 COMMERCE AVE
Mailing Address - Street 2:STE. E
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-3884
Mailing Address - Country:US
Mailing Address - Phone:818-602-5163
Mailing Address - Fax:661-252-2513
Practice Address - Street 1:650 COMMERCE AVE
Practice Address - Street 2:STE. E
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-3884
Practice Address - Country:US
Practice Address - Phone:818-602-5163
Practice Address - Fax:661-252-2513
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-18
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA202612251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1154788404OtherPHYSICAL THERAPIST
CA1154788404OtherPHYSICAL THERAPY