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NPI Code Detail

MEDICARE: MORIBA SANNOH

MEDICARE: MORIBA SANNOH
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 TechnicianMN

General Provider Information

NPI Number : 1881467116
Entity Type Code : Individual
Provider Name (Legal Business Name) : MORIBA SANNOH
Provider Business Mailing Address
First Line : 2669 SCOTLAND COURT
Second Line : 309
City : MOUNDS VIEW
State : MN
Zip : 55112
Country : US
Telephone Number : 801-916-9813
Fax Number :
Provider Business Practice Location Address
First Line : 1627 WHITE BEAR AVE N
Second Line :
City : SAINT PAUL
State : MN
Zip : 55106-1609
Country : US
Telephone Number : 651-278-7319
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/30/2023
Last Update Date : 10/30/2023

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Directions to “ MORIBA SANNOH ” Practice Location

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