Healthcare Provider Details

I. General information

NPI: 1932011145
Provider Name (Legal Business Name): JONATHAN DOMINIC PINTO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1917 W C ST
JENKS OK
74037-2367
US

IV. Provider business mailing address

1917 W C ST
JENKS OK
74037-2367
US

V. Phone/Fax

Practice location:
  • Phone: 918-850-5639
  • Fax: 918-777-3415
Mailing address:
  • Phone: 918-850-5639
  • Fax: 918-777-3415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: