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NPI Code Detail

MEDICARE: STEPHEN OMONDI

MEDICARE: STEPHEN OMONDI
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1154834695
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHEN OMONDI
Provider Business Mailing Address
First Line : 41521 W 11 MILE RD
Second Line :
City : NOVI
State : MI
Zip : 48375-1803
Country : US
Telephone Number : 248-299-0030
Fax Number :
Provider Business Practice Location Address
First Line : 101 H ST STE L
Second Line :
City : PETALUMA
State : CA
Zip : 94952-5100
Country : US
Telephone Number : 866-206-2008
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/07/2017
Last Update Date : 12/10/2018

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Directions to “ STEPHEN OMONDI ” Practice Location

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