Healthcare Provider Details

I. General information

NPI: 1871385039
Provider Name (Legal Business Name): CARMELA AVALOS
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2025
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 N CLASSEN BLVD
OKLAHOMA CITY OK
73106-6835
US

IV. Provider business mailing address

1118 N PURDUE AVE
OKLAHOMA CITY OK
73127-3910
US

V. Phone/Fax

Practice location:
  • Phone: 405-601-6710
  • Fax:
Mailing address:
  • Phone: 405-473-2671
  • 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: