Individual
JESUS DUARTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
291 N. STEVENS LN., LOT 13, PARKS, AZ 86018
(928) 600-5544
Mailing address
PO BOX 50224, PARKS, AZ 86018-0224
(928) 600-5544
Taxonomy
Speciality
Code
Description
License number
State
385HR2055X
Child Mental Illness Respite Care
Primary
3887
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
738148
AHCCCS ID
AZ
Enumeration date
12/05/2006
Last updated
07/08/2007
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