Healthcare Provider Details

I. General information

NPI: 1730003294
Provider Name (Legal Business Name): MIGUEL A DURAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6044 S 16TH ST STE 180
PHOENIX AZ
85042-4472
US

IV. Provider business mailing address

6044 S 16TH ST STE 180
PHOENIX AZ
85042-4472
US

V. Phone/Fax

Practice location:
  • Phone: 602-350-9547
  • Fax:
Mailing address:
  • Phone: 602-350-9547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number25085810
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: