=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992044630
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DANILO M DUENAS M D LTD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2013
-----------------------------------------------------
Last Update Date | 01/31/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3150 N TENAYA WAY SUITE 450
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89128-0443
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-796-0300
-----------------------------------------------------
Fax | 702-796-7614
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 36656
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89133-6656
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-796-0300
-----------------------------------------------------
Fax | 702-796-7614
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DANILO M DUENAS
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 702-796-0300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 7917
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------