Provider Demographics
NPI:1962056457
Name:DURAN, ALEJANDRO SAUL (OT)
Entity type:Individual
Prefix:
First Name:ALEJANDRO
Middle Name:SAUL
Last Name:DURAN
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:ALEXANDER
Other - Middle Name:RAUL
Other - Last Name:OSES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6828 HAYWOOD ST
Mailing Address - Street 2:
Mailing Address - City:TUJUNGA
Mailing Address - State:CA
Mailing Address - Zip Code:91042-2850
Mailing Address - Country:US
Mailing Address - Phone:323-868-7612
Mailing Address - Fax:
Practice Address - Street 1:150 MUIR RD
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-4668
Practice Address - Country:US
Practice Address - Phone:925-372-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-01
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17174225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist