MEDICARE: HAGAR AFFIFY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1053870766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAGAR AFFIFY

Provider Business Mailing Address
First Line	:	2800 NW 192ND ST APT 18301
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73012-9187
Country	:	US
Telephone Number	:	918-691-6042
Fax Number	:

Provider Business Practice Location Address
First Line	:	13905 TECHNOLOGY DR # A1
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73134-1054
Country	:	US
Telephone Number	:	405-389-4530
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2019
Last Update Date	:	07/10/2024

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