Healthcare Provider Details

I. General information

NPI: 1568530137
Provider Name (Legal Business Name): CECILIA CARUBELLI GUTHRIE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CECILIA MARIA CARUBELLI M.D.

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 05/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 CHILDRENS AVE
OKLAHOMA CITY OK
73104-4637
US

IV. Provider business mailing address

940 NE 13TH ST # 2G-2300
OKLAHOMA CITY OK
73104-5008
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-2429
  • Fax: 405-271-2421
Mailing address:
  • Phone: 405-271-2429
  • Fax: 405-271-2421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number19971
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: