MEDICARE: JOHNATHEN DURAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1033567276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHNATHEN DURAN

Provider Business Mailing Address
First Line	:	9000 LAS VEGAS BLVD S
Second Line	:	UNIT 2236
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-3367
Country	:	US
Telephone Number	:	714-274-3348
Fax Number	:

Provider Business Practice Location Address
First Line	:	9000 LAS VEGAS BLVD S
Second Line	:	UNIT 2236
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-3367
Country	:	US
Telephone Number	:	714-274-3348
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2016
Last Update Date	:	06/28/2016

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Directions to “ JOHNATHEN DURAN ” Practice Location

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