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Individual
MR. JORGE A. DUQUE
Active
Individual
MR. JORGE A. DUQUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
65726
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ91891Z
MEDICARE SITE GROUP PTAN# SANTA CRUZ COUNTY CA
CA
01
—
ZZZ91892Z
MEDICARE SITE GROUP PTAN# SANTA CRUZ COUNTY CA
CA
01
—
ZZZ92069Z
MEDICARE SITE GROUP PTAN# SANTA CRUZ COUNTY CA
CA
Enumeration date
02/25/2008
Last updated
05/11/2017
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