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NPI Code Detail

MEDICARE: KIMBERLY SOGUNRO

MEDICARE: KIMBERLY SOGUNRO
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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1407303746
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY SOGUNRO
Provider Business Mailing Address
First Line : 3517 RIDGLEA CT
Second Line :
City : DEL CITY
State : OK
Zip : 73115-1831
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3517 RIDGLEA CT
Second Line :
City : DEL CITY
State : OK
Zip : 73115-1831
Country : US
Telephone Number : 405-226-3446
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/02/2016
Last Update Date : 09/02/2016

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Directions to “ KIMBERLY SOGUNRO ” Practice Location

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