Healthcare Provider Details

I. General information

NPI: 1306536503
Provider Name (Legal Business Name): MALVIN DURAN ACEBUCHE NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2023
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 NELSON AVE
FARMINGTON NM
87401-3362
US

IV. Provider business mailing address

401 NELSON AVE APT 1104
FARMINGTON NM
87401-3366
US

V. Phone/Fax

Practice location:
  • Phone: 917-972-6925
  • Fax:
Mailing address:
  • Phone: 917-972-6925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number84811
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number818506
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberR63659
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberR63659
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: