1639399124 NPI number — MRS. SUSAN JONES CASTILLO XRAY TECHNOLOGIST

Table of content: MRS. SUSAN JONES CASTILLO XRAY TECHNOLOGIST (NPI 1639399124)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639399124 NPI number — MRS. SUSAN JONES CASTILLO XRAY TECHNOLOGIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASTILLO
Provider First Name:
SUSAN
Provider Middle Name:
JONES
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
XRAY TECHNOLOGIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JONES
Provider Other First Name:
SUSAN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
REGISTERED
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1639399124
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9700 S BROOKLINE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73159-7000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-213-9008
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5900 MOSTELLER DR
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73112-4600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-842-0430
Provider Business Practice Location Address Fax Number:
405-810-8775
Provider Enumeration Date:
04/26/2007

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: 2471C3402X , with the licence number:  143847 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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