Individual
JACKIE DURAZO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
561 FLORIDA ST, IMPERIAL BEACH, CA 91932-1655
(619) 483-7115
Mailing address
1128 26TH ST, SAN DIEGO, CA 92102-1004
(619) 802-5527
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Enumeration date
03/02/2026
Last updated
03/02/2026
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