Provider Demographics
NPI:1366764532
Name:DURAN, JESUS ANTONIO (PA-C)
Entity type:Individual
Prefix:
First Name:JESUS
Middle Name:ANTONIO
Last Name:DURAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:TONY
Other - Middle Name:
Other - Last Name:DURAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:314 NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3730
Mailing Address - Country:US
Mailing Address - Phone:559-791-7000
Mailing Address - Fax:559-781-8193
Practice Address - Street 1:33025 ROAD 159
Practice Address - Street 2:
Practice Address - City:IVANHOE
Practice Address - State:CA
Practice Address - Zip Code:93235-1234
Practice Address - Country:US
Practice Address - Phone:559-798-1877
Practice Address - Fax:559-798-1058
Is Sole Proprietor?:No
Enumeration Date:2010-02-16
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20805363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant