1215271101 NPI number — DR. DEZIREE ANGELITA DURAYAPPAH D.O.

Table of content: DR. DEZIREE ANGELITA DURAYAPPAH D.O. (NPI 1215271101)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215271101 NPI number — DR. DEZIREE ANGELITA DURAYAPPAH D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DURAYAPPAH
Provider First Name:
DEZIREE
Provider Middle Name:
ANGELITA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BARKER
Provider Other First Name:
DEZIREE
Provider Other Middle Name:
ANGELITA
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.O.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1215271101
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/23/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
232288 E 640 RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEILING
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73663-6620
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-430-3357
Provider Business Mailing Address Fax Number:
346-297-2990

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
232288 E 640 RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEILING
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73663-6620
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-430-3357
Provider Business Practice Location Address Fax Number:
346-297-2990
Provider Enumeration Date:
11/16/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  S4292 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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