Healthcare Provider Details

I. General information

NPI: 1528567526
Provider Name (Legal Business Name): CYNTHIA KIBOKO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2018
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20414 N 27TH AVE STE 410
PHOENIX AZ
85027-3250
US

IV. Provider business mailing address

802 N 1ST AVE UNIT 1423
PHOENIX AZ
85003-1835
US

V. Phone/Fax

Practice location:
  • Phone: 623-263-3966
  • Fax:
Mailing address:
  • Phone: 832-882-2224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number00004654
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-17-47041
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: