Healthcare Provider Details

I. General information

NPI: 1841315751
Provider Name (Legal Business Name): ALEXANDRA C OBIORA-OPUTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 KS HIGHWAY 264
LARNED KS
67550-5353
US

IV. Provider business mailing address

1301 KS HWY 264
LARNED KS
67550-5353
US

V. Phone/Fax

Practice location:
  • Phone: 620-804-1027
  • Fax:
Mailing address:
  • Phone: 620-804-1027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberP32589
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0800303
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: