Provider Demographics
NPI:1396314191
Name:FALERO DURAN, LUIS X
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:X
Last Name:FALERO 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 1:5955 NW 105TH CT APT 311
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-6648
Mailing Address - Country:US
Mailing Address - Phone:787-451-7030
Mailing Address - Fax:
Practice Address - Street 1:5955 NW 105TH CT APT 311
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-6648
Practice Address - Country:US
Practice Address - Phone:787-451-7030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-24
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11012517367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered