Basic Information
Provider Information
NPI: 1376872838
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DUARTE
FirstName: AMADO
MiddleName: BEN
NamePrefix: MR.
NameSuffix:  
Credential: CAS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4705 N SONORA AVE
Address2: SUITE 113
City: FRESNO
State: CA
PostalCode: 937223966
CountryCode: US
TelephoneNumber: 5592767558
FaxNumber: 5592767568
Practice Location
Address1: 4705 N SONORA AVE
Address2: SUITE 113
City: FRESNO
State: CA
PostalCode: 937223966
CountryCode: US
TelephoneNumber: 5592767558
FaxNumber: 5592767568
Other Information
ProviderEnumerationDate: 12/12/2009
LastUpdateDate: 12/12/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
170300000X  Y Other Service ProvidersGenetic Counselor, MS 

No ID Information.


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