Individual
TITO DURAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1309 W 159TH ST, GARDENA, CA 90247-4323
(310) 217-0437
(424) 378-6334
Mailing address
1309 W 159TH ST, GARDENA, CA 90247-4323
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
960000990
CA
Other
Enumeration date
07/29/2025
Last updated
07/29/2025
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