Healthcare Provider Details

I. General information

NPI: 1639399124
Provider Name (Legal Business Name): SUSAN JONES CASTILLO XRAY TECHNOLOGIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN JONES REGISTERED

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 MOSTELLER DR SUITE 150
OKLAHOMA CITY OK
73112-4600
US

IV. Provider business mailing address

9700 S BROOKLINE AVE
OKLAHOMA CITY OK
73159-7000
US

V. Phone/Fax

Practice location:
  • Phone: 405-842-0430
  • Fax: 405-810-8775
Mailing address:
  • Phone: 405-213-9008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number143847
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: