Healthcare Provider Details

I. General information

NPI: 1790337830
Provider Name (Legal Business Name): ADALBERTO DURAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2019
Last Update Date: 05/31/2021
Certification Date: 05/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7819 W 18TH LN
HIALEAH FL
33014-3217
US

IV. Provider business mailing address

7819 W 18TH LN
HIALEAH FL
33014-3217
US

V. Phone/Fax

Practice location:
  • Phone: 305-648-9344
  • Fax:
Mailing address:
  • Phone: 786-447-4536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-21-12067
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: