Healthcare Provider Details

I. General information

NPI: 1427821859
Provider Name (Legal Business Name): REEJA KURUVILLA DANIEL PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2023
Last Update Date: 11/07/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 CHILDRENS AVE STE 9A
OKLAHOMA CITY OK
73104-4637
US

IV. Provider business mailing address

2413 NW 159TH TER
EDMOND OK
73013-7312
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-2234
  • Fax:
Mailing address:
  • Phone: 405-812-6729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number5135
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: