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NPI Code Detail

MEDICARE: SARAI PEGUERO

MEDICARE: SARAI PEGUERO
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1174016612
Entity Type Code : Individual
Provider Name (Legal Business Name) : SARAI PEGUERO
Provider Business Mailing Address
First Line : 504 BRIGHTON DR
Second Line :
City : EDMOND
State : OK
Zip : 73003-3169
Country : US
Telephone Number : 817-709-9508
Fax Number :
Provider Business Practice Location Address
First Line : 425 S FRETZ AVE STE C
Second Line :
City : EDMOND
State : OK
Zip : 73003-5568
Country : US
Telephone Number : 405-726-9808
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2018
Last Update Date : 06/10/2018

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Directions to “ SARAI PEGUERO ” Practice Location

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