Provider Demographics
NPI:1679806806
Name:DURAN, EDUARDO MADRID
Entity Type:Individual
Prefix:
First Name:EDUARDO
Middle Name:MADRID
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 1:680 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-2920
Mailing Address - Country:US
Mailing Address - Phone:760-482-0864
Mailing Address - Fax:760-482-9185
Practice Address - Street 1:680 W MAIN ST
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-2920
Practice Address - Country:US
Practice Address - Phone:760-482-0864
Practice Address - Fax:760-482-9185
Is Sole Proprietor?:No
Enumeration Date:2009-09-04
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor