Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 021699 | PR |
NPI | 1003301466 |
---|---|
Provider Name | Dr. Jessica Marie Reyes Giusti |
First Address | Oklahoma City, OK 73104-5007 |
Second Address | Oklahoma City, OK 73104-5007 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2018 |
Last Update Date | 12/08/2020 |