Provider Demographics
NPI:1578355004
Name:DURAN CARDOSO, MICHEL
Entity type:Individual
Prefix:
First Name:MICHEL
Middle Name:
Last Name:DURAN CARDOSO
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 1:6508 BRISTOL WAY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-3309
Mailing Address - Country:US
Mailing Address - Phone:702-417-4429
Mailing Address - Fax:
Practice Address - Street 1:6508 BRISTOL WAY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-3309
Practice Address - Country:US
Practice Address - Phone:702-417-4429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA103145171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter