Provider Demographics
NPI:1962243360
Name:RANDALL, SAKIMO
Entity type:Individual
Prefix:
First Name:SAKIMO
Middle Name:
Last Name:RANDALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5801 GOLDEN TRIANGLE BLVD STE 103-109
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-4400
Mailing Address - Country:US
Mailing Address - Phone:972-400-0537
Mailing Address - Fax:
Practice Address - Street 1:5801 GOLDEN TRIANGLE BLVD STE 103-109
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-4400
Practice Address - Country:US
Practice Address - Phone:972-400-0537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health