Healthcare Provider Details

I. General information

NPI: 1609935931
Provider Name (Legal Business Name): SUZANNA DURAN MT(ASCP)
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 ABALONE LOOP
MESCALERO NM
88340
US

IV. Provider business mailing address

104 ROONEY
RUIDOSO NM
88345-6654
US

V. Phone/Fax

Practice location:
  • Phone: 505-464-3840
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: