Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003248949 |
---|---|
Provider Name | Patches Razo |
First Address | Mcalester, OK 74501-4815 |
Second Address | Mcalester, OK 74501-4815 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2013 |
Last Update Date | 02/08/2013 |