Individual
EZRA ROBERT NORDIN DUREAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPT
Contact information
Practice address
902 S MYRTLE AVE, MONROVIA, CA 91016-3427
(626) 357-3258
Mailing address
160 E PASADENA ST, POMONA, CA 91767-4604
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
PT41197
CA
Other
Enumeration date
02/03/2020
Last updated
02/03/2020
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