Provider Demographics
NPI:1396085858
Name:DUARTE, ANA PAULA (LAC)
Entity type:Individual
Prefix:
First Name:ANA PAULA
Middle Name:
Last Name:DUARTE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S IRENA AVE
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-3428
Mailing Address - Country:US
Mailing Address - Phone:619-203-5523
Mailing Address - Fax:
Practice Address - Street 1:419 TORRANCE BLVD
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-3326
Practice Address - Country:US
Practice Address - Phone:310-542-1856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-20
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02034171100000X
CA14832171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist