Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 31186 | AZ |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 31186 | AZ |
NPI | 1114971363 |
---|---|
Provider Name | Cynthia L Kooima |
First Address | Salt Lake City, UT 84127-1429 |
Second Address | Gilbert, AZ 85234-2168 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2006 |
Last Update Date | 27/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
115551 | (05) | AZ |
3Z3971 | HEALTHNET (01) | AZ |