Healthcare Provider Details

I. General information

NPI: 1528168721
Provider Name (Legal Business Name): GITA - PUJARI II M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GITA PUJARI II MD

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 NE 13TH ST 116C
OKLAHOMA CITY OK
73104-5007
US

IV. Provider business mailing address

921 NE 13TH ST 116C
OKLAHOMA CITY OK
73104-5007
US

V. Phone/Fax

Practice location:
  • Phone: 405-270-0501
  • Fax: 405-270-6656
Mailing address:
  • Phone: 405-270-0501
  • Fax: 405-270-6656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number18823
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: