Healthcare Provider Details

I. General information

NPI: 1245136456
Provider Name (Legal Business Name): DIEGO KEATON ARVIZU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2026
Last Update Date: 10/15/2026
Certification Date: 10/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 W QUEENS ST
BROKEN ARROW OK
74012-1767
US

IV. Provider business mailing address

4414 E 14TH PL
TULSA OK
74112-6110
US

V. Phone/Fax

Practice location:
  • Phone: 479-318-2300
  • Fax:
Mailing address:
  • Phone: 918-908-0356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: