Provider Information for 1215367651
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RUTANYA SIMON
Sex: Female
NPI: 1215367651
Last Updated: 2024-01-09
Certification Date: 2024-01-09
Certification Date: 2024-01-09
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1215367651 | ||||||||||||
| Enumeration Date | 2013-11-21 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 650 S PEORIA AVE TULSA, OK 74120-4429 United States Phone: 918-587-9471 | Fax:918-560-1399 | ||||||||||||
| Primary Practice Address | 3604 N MARTIN LUTHER KING JR BLVD TULSA, OK 74106-6447 United States Phone: 918-425-4200 | Fax:918-425-4202 | ||||||||||||
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