Provider Demographics
NPI:1609420728
Name:DURAZO, JENNIFER KRYSTAL
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KRYSTAL
Last Name:DURAZO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 E BROKAW RD STE 150
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-4221
Mailing Address - Country:US
Mailing Address - Phone:209-465-1080
Mailing Address - Fax:209-465-2709
Practice Address - Street 1:97 E BROKAW RD STE 150
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-4221
Practice Address - Country:US
Practice Address - Phone:209-465-1080
Practice Address - Fax:209-465-2709
Is Sole Proprietor?:No
Enumeration Date:2019-07-26
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner