Provider Demographics
NPI:1023190279
Name:DUENAS, DANILO MOLERA (MD)
Entity Type:Individual
Prefix:DR
First Name:DANILO
Middle Name:MOLERA
Last Name:DUENAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3860 W LAKE MEAD BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-5203
Mailing Address - Country:US
Mailing Address - Phone:702-577-1910
Mailing Address - Fax:702-546-7517
Practice Address - Street 1:3860 W LAKE MEAD BLVD STE 100
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-5203
Practice Address - Country:US
Practice Address - Phone:702-577-1910
Practice Address - Fax:702-546-7517
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7917207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1023190279Medicaid
NVVMD7917Medicare PIN
NVG32316Medicare UPIN