Healthcare Provider Details

I. General information

NPI: 1902260565
Provider Name (Legal Business Name): JACLYN C URQUIOLA SORZANO D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2016
Last Update Date: 06/06/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

9100 NW 117TH ST
YUKON OK
73099-8945
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-2429
  • Fax: 407-975-0413
Mailing address:
  • Phone: 786-390-6297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS16013
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number7610
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: