Healthcare Provider Details

I. General information

NPI: 1275092488
Provider Name (Legal Business Name): CATHERINE O OKOUKONI MD/PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 03/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5077 NW 125TH AVE
CORAL SPRINGS FL
33076-3448
US

IV. Provider business mailing address

5077 NW 125TH AVE
CORAL SPRINGS FL
33076-3448
US

V. Phone/Fax

Practice location:
  • Phone: 954-918-8219
  • Fax:
Mailing address:
  • Phone: 954-918-8219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: