MEDICARE: GINNY KOKORUDZ MBA

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
1	171400000X	Health & Wellness Coach		AZ

General Provider Information

NPI Number	:	1548192677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINNY KOKORUDZ MBA

Provider Business Mailing Address
First Line	:	4820 E FORT LOWELL RD UNIT C
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-1262
Country	:	US
Telephone Number	:	406-465-8705
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 N COUNTRY CLUB RD STE 100
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85716-4530
Country	:	US
Telephone Number	:	406-465-8705
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2026
Last Update Date	:	06/02/2026

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Directions to “ GINNY KOKORUDZ MBA” Practice Location

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