Healthcare Provider Details

I. General information

NPI: 1255751145
Provider Name (Legal Business Name): OKONO OKONO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2014
Last Update Date: 07/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 NW 150TH ST APT 26H
OKLAHOMA CITY OK
73134-2017
US

IV. Provider business mailing address

3101 NW 150TH ST APT 26H
OKLAHOMA CITY OK
73134-2017
US

V. Phone/Fax

Practice location:
  • Phone: 832-373-5101
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: