Healthcare Provider Details

I. General information

NPI: 1689544413
Provider Name (Legal Business Name): OMAYRA SANTIAGO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2025
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4518 N IROQUOIS AVE
TULSA OK
74106-1306
US

IV. Provider business mailing address

4518 N IROQUOIS AVE
TULSA OK
74106-1306
US

V. Phone/Fax

Practice location:
  • Phone: 513-399-2066
  • Fax:
Mailing address:
  • Phone: 513-399-2066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: