MEDICARE: JESSICA 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	106E00000X	Assistant Behavior Analyst

General Provider Information

NPI Number	:	1902346539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA DURAN

Provider Business Mailing Address
First Line	:	4442 EL TOVAR RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89115-5423
Country	:	US
Telephone Number	:	702-771-5518
Fax Number	:

Provider Business Practice Location Address
First Line	:	4442 EL TOVAR RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89115-5423
Country	:	US
Telephone Number	:	702-771-5518
Fax Number	:

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

Provider Enumeration Date	:	03/01/2017
Last Update Date	:	03/01/2017

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