Provider Demographics
NPI:1306536503
Name:ACEBUCHE, MALVIN DURAN (NP)
Entity type:Individual
Prefix:
First Name:MALVIN
Middle Name:DURAN
Last Name:ACEBUCHE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 NELSON AVE APT 1104
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-3366
Mailing Address - Country:US
Mailing Address - Phone:917-972-6925
Mailing Address - Fax:
Practice Address - Street 1:3535 LAS VEGAS BLVD S STE G101
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-8921
Practice Address - Country:US
Practice Address - Phone:702-778-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-10
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR63659163WE0003X, 163WH0200X
NM818506363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No163WH0200XNursing Service ProvidersRegistered NurseHome Health