Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225C00000X | Rehabilitation Counselor |
NPI | 1225269004 |
---|---|
Provider Name | Mr. Enrique Madrid Duran |
First Address | Upland, CA 91786 |
Second Address | Upland, CA 91786 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2009 |
Last Update Date | 04/12/2013 |