Provider Demographics
NPI:1194096917
Name:DURAND, MARI-ELENA
Entity type:Individual
Prefix:
First Name:MARI-ELENA
Middle Name:
Last Name:DURAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARI-ELENA
Other - Middle Name:
Other - Last Name:GIAGOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4010 MOORPARK AVE
Mailing Address - Street 2:117
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95117-4101
Mailing Address - Country:US
Mailing Address - Phone:408-249-0770
Mailing Address - Fax:408-834-7767
Practice Address - Street 1:4010 MOORPARK AVE
Practice Address - Street 2:117
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95117-4101
Practice Address - Country:US
Practice Address - Phone:408-249-0770
Practice Address - Fax:408-834-7767
Is Sole Proprietor?:No
Enumeration Date:2012-01-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14096235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist