Healthcare Provider Details

I. General information

NPI: 1659612281
Provider Name (Legal Business Name): BRYAN HENRY LAFUENTE CP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2013
Last Update Date: 04/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 NW 9TH ST SUITE 1
OKLAHOMA CITY OK
73102-2619
US

IV. Provider business mailing address

229 NW 9TH ST SUITE 1
OKLAHOMA CITY OK
73102-2619
US

V. Phone/Fax

Practice location:
  • Phone: 405-974-1548
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: