Provider Demographics
NPI:1417293283
Name:DUARTE, JOSE LUIS (PA-C)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:LUIS
Last Name:DUARTE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3036 SANTA FE AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90810-2744
Mailing Address - Country:US
Mailing Address - Phone:562-591-2785
Mailing Address - Fax:
Practice Address - Street 1:9301 WILSHIRE BLVD STE 404
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-6137
Practice Address - Country:US
Practice Address - Phone:310-278-9171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-21
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA22674363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant