Healthcare Provider Details

I. General information

NPI: 1093074023
Provider Name (Legal Business Name): SERGE DJIMI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2012
Last Update Date: 02/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 ALAMEDA ST APT 216
NORMAN OK
73071-2195
US

IV. Provider business mailing address

2021 ALAMEDA ST APT 216
NORMAN OK
73071-2195
US

V. Phone/Fax

Practice location:
  • Phone: 405-549-3904
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: