Provider Demographics
NPI:1033567276
Name:DURAN, JOHNATHEN
Entity Type:Individual
Prefix:
First Name:JOHNATHEN
Middle Name:
Last Name:DURAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 LAS VEGAS BLVD S
Mailing Address - Street 2:UNIT 2236
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-3367
Mailing Address - Country:US
Mailing Address - Phone:714-274-3348
Mailing Address - Fax:
Practice Address - Street 1:9000 LAS VEGAS BLVD S
Practice Address - Street 2:UNIT 2236
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-3367
Practice Address - Country:US
Practice Address - Phone:714-274-3348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-27
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker