Healthcare Provider Details

I. General information

NPI: 1548192677
Provider Name (Legal Business Name): GINNY KOKORUDZ MBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 N COUNTRY CLUB RD STE 100
TUCSON AZ
85716-4530
US

IV. Provider business mailing address

4820 E FORT LOWELL RD UNIT C
TUCSON AZ
85712-1262
US

V. Phone/Fax

Practice location:
  • Phone: 406-465-8705
  • Fax:
Mailing address:
  • Phone: 406-465-8705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: