Healthcare Provider Details

I. General information

NPI: 1760715874
Provider Name (Legal Business Name): LEO DURAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2009
Last Update Date: 11/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 SILER RD BUILDING A
SANTA FE NM
87507-3541
US

IV. Provider business mailing address

1301 SILER ROAD BUILDING A
SANTA FE NM
87507
US

V. Phone/Fax

Practice location:
  • Phone: 505-476-8352
  • Fax: 505-424-3438
Mailing address:
  • Phone: 505-476-8352
  • Fax: 505-424-3438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00006254
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: