Provider Demographics
NPI:1831955012
Name:DURAN, SANDRA AMALIA
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:AMALIA
Last Name:DURAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:AMALIA
Other - Last Name:LEON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 8012
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-8012
Mailing Address - Country:US
Mailing Address - Phone:310-489-7557
Mailing Address - Fax:
Practice Address - Street 1:1455 W PARK AVE
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-8178
Practice Address - Country:US
Practice Address - Phone:909-793-2225
Practice Address - Fax:909-793-2221
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19005225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist