Healthcare Provider Details

I. General information

NPI: 1619772522
Provider Name (Legal Business Name): JUANITA ESMERALDA GONZALEZ CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2025
Last Update Date: 02/14/2025
Certification Date: 02/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 NE 13TH ST STE 1G
OKLAHOMA CITY OK
73104-5040
US

IV. Provider business mailing address

1000 NE 13TH ST STE 1G
OKLAHOMA CITY OK
73104-5040
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-8001
  • Fax: 405-271-1531
Mailing address:
  • Phone: 405-271-8001
  • Fax: 405-271-1531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number20745
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: