Healthcare Provider Details

I. General information

NPI: 1982303830
Provider Name (Legal Business Name): DANIEL DUPONT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2023
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MSCO8 4720 1 UNM
ALBUQUERQUE NM
87131-5888
US

IV. Provider business mailing address

2718 HYDER AVE SE
ALBUQUERQUE NM
87106-3033
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-2321
  • Fax:
Mailing address:
  • Phone: 801-520-5694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRS2025-0208
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: