Provider Demographics
NPI:1114235082
Name:DUJUNCO, NATHANIEL CO
Entity Type:Individual
Prefix:MR
First Name:NATHANIEL
Middle Name:CO
Last Name:DUJUNCO
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 1:2330 NEVADA AVE
Mailing Address - Street 2:APARTMENT 1009, SUNRIDGE VILLAGE APARTMENTS
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-1413
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2961 N ROADRUNNER PKWY
Practice Address - Street 2:CAMINO REAL MIDDLE SCHOOL
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-1618
Practice Address - Country:US
Practice Address - Phone:575-527-6030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-4680235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist