Provider Demographics
NPI:1699106575
Name:DURAN, BRENDAN (IDC)
Entity type:Individual
Prefix:
First Name:BRENDAN
Middle Name:
Last Name:DURAN
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2947 UNICORNIO ST APT A
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-4441
Mailing Address - Country:US
Mailing Address - Phone:217-553-8662
Mailing Address - Fax:
Practice Address - Street 1:2947 UNICORNIO ST APT A
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-4441
Practice Address - Country:US
Practice Address - Phone:217-553-8662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-03
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman