Provider Demographics
NPI:1407505928
Name:DURANONA, CHARLES ALEXANDER
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:ALEXANDER
Last Name:DURANONA
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 1:504 E 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1406
Mailing Address - Country:US
Mailing Address - Phone:509-319-7067
Mailing Address - Fax:
Practice Address - Street 1:504 E 2ND AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1406
Practice Address - Country:US
Practice Address - Phone:509-319-7067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker