MEDICARE: SENCERA LONGORIA

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	235Z00000X	Speech-Language Pathologist	3889	OK

General Provider Information

NPI Number	:	1659731776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SENCERA LONGORIA

Provider Business Mailing Address
First Line	:	1312 SW 109TH PL
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73170-4210
Country	:	US
Telephone Number	:	405-476-2029
Fax Number	:

Provider Business Practice Location Address
First Line	:	1312 SW 109TH PL
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73170-4210
Country	:	US
Telephone Number	:	405-476-2029
Fax Number	:

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

Provider Enumeration Date	:	03/02/2016
Last Update Date	:	03/02/2016

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Directions to “ SENCERA LONGORIA ” Practice Location

Language	Start Address	Practice Location

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