Basic Information
| Provider Information | |||||||||
| NPI: | 1194096917 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DURAND | ||||||||
| FirstName: | MARI-ELENA | ||||||||
| MiddleName: | |||||||||
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| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GIAGOS | ||||||||
| OtherFirstName: | MARI-ELENA | ||||||||
| OtherMiddleName: | |||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4010 MOORPARK AVE | ||||||||
| Address2: | 117 | ||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951174101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4082490770 | ||||||||
| FaxNumber: | 4088347767 | ||||||||
| Practice Location | |||||||||
| Address1: | 4010 MOORPARK AVE | ||||||||
| Address2: | 117 | ||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951174101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4082490770 | ||||||||
| FaxNumber: | 4088347767 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2012 | ||||||||
| LastUpdateDate: | 01/25/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 14096 | CA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.