Provider Demographics
NPI:1275804767
Name:DURAN, ALBERTO A
Entity Type:Individual
Prefix:
First Name:ALBERTO
Middle Name:A
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 1:8311 MOUNT RANIER DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79904-2904
Mailing Address - Country:US
Mailing Address - Phone:915-790-3085
Mailing Address - Fax:
Practice Address - Street 1:101 MAGUEY CT
Practice Address - Street 2:SUITE 1
Practice Address - City:SUNLAND PARK
Practice Address - State:NM
Practice Address - Zip Code:88063-9513
Practice Address - Country:US
Practice Address - Phone:575-589-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-16
Last Update Date:2012-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
NMI057690103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst