1356071724 NPI number — MAYUME PRESENTA GARCIA CRNA

Table of content: MAYUME PRESENTA GARCIA CRNA (NPI 1356071724)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356071724 NPI number — MAYUME PRESENTA GARCIA CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARCIA
Provider First Name:
MAYUME
Provider Middle Name:
PRESENTA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356071724
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6839 S CANTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TULSA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74136-3402
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-494-0612
Provider Business Mailing Address Fax Number:
918-481-5170

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6161 S YALE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74136-1902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-494-0612
Provider Business Practice Location Address Fax Number:
918-481-5170
Provider Enumeration Date:
06/16/2022

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: 163W00000X , with the licence number:  832887 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 210569 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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