Healthcare Provider Details

I. General information

NPI: 1598670697
Provider Name (Legal Business Name): PABLE SEBASTIAN CRUZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9902 E 43RD ST STE A
TULSA OK
74146-4756
US

IV. Provider business mailing address

PO BOX 691461
TULSA OK
74169-1461
US

V. Phone/Fax

Practice location:
  • Phone: 918-280-9072
  • Fax: 539-399-7513
Mailing address:
  • Phone: 918-280-9072
  • Fax: 539-399-7513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-2839501
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: