Doctor Name: | MR. MOSES SGUNRO |
NPI Number: | 1619211349 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | |
Business Practice Address: | 3517 Ridglea Ct Del City, OK - 731151831 |
Business Phone Number: | 4056728201 |
Business Fax Number: | |
Mailing Address: | 3517 Ridglea Ct, DEL CITY |
State: | OK |
Postal Code: | 731151831 |
Phone Number: | 4056728201 |
Fax Number: | |
NPI Enumeration Date: | 11/19/2012 |
NPI Last Update Date: | 12/05/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | OK |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |