Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1003121948 |
---|---|
Provider Name | Henry P Durazo |
First Address | Culver City, CA 90232-2732 |
Second Address | Culver City, CA 90232-2732 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2010 |
Last Update Date | 20/06/2018 |