Provider Demographics
NPI:1588207229
Name:DUROL, FERDINAND BENITO
Entity Type:Individual
Prefix:
First Name:FERDINAND
Middle Name:BENITO
Last Name:DUROL
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 1:3890 CAMBRIDGE ST APT 102
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-7577
Mailing Address - Country:US
Mailing Address - Phone:702-290-6287
Mailing Address - Fax:
Practice Address - Street 1:2715 E RUSSELL RD APT 102
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-2426
Practice Address - Country:US
Practice Address - Phone:702-290-6287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-25
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician