Healthcare Provider Details

I. General information

NPI: 1457833725
Provider Name (Legal Business Name): LINDA MELODY GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2018
Last Update Date: 09/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1390 S DOUGLAS BLVD STE 102
MIDWEST CITY OK
73130-5271
US

IV. Provider business mailing address

8301 N COUNCIL RD APT 2302
OKLAHOMA CITY OK
73132-4189
US

V. Phone/Fax

Practice location:
  • Phone: 405-455-5312
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: