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NPI Code Detail

MEDICARE: MR. ENRICO MIGUEL JAURDON M.A.,

MEDICARE: MR. ENRICO MIGUEL JAURDON M.A.,
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
1101Y00000XCounselor

General Provider Information

NPI Number : 1184985749
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ENRICO MIGUEL JAURDON M.A.,
Provider Business Mailing Address
First Line : 625 NW 112TH ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73114-6837
Country : US
Telephone Number : 405-413-7856
Fax Number :
Provider Business Practice Location Address
First Line : 2828 NW 57TH ST
Second Line : SUITE 302
City : OKLAHOMA CITY
State : OK
Zip : 73112-6814
Country : US
Telephone Number : 405-840-1243
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/30/2012
Last Update Date : 04/17/2013

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