Healthcare Provider Details

I. General information

NPI: 1043078140
Provider Name (Legal Business Name): DIONELIS JAELISSE BARRIOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DIONELIS JAELISSE SANCHEZ JIMENEZ

II. Dates (important events)

Enumeration Date: 03/12/2024
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 NE 13TH ST
OKLAHOMA CITY OK
73104-5007
US

IV. Provider business mailing address

812 BLUE FISH RD
NORMAN OK
73069-5394
US

V. Phone/Fax

Practice location:
  • Phone: 305-401-9351
  • Fax:
Mailing address:
  • Phone: 305-401-9352
  • Fax: 305-401-9351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: