Healthcare Provider Details

I. General information

NPI: 1922881135
Provider Name (Legal Business Name): PEYTON SIFUENTES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2023
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5723 E 24TH PL
TULSA OK
74114-3813
US

IV. Provider business mailing address

5723 E 24TH PL
TULSA OK
74114-3813
US

V. Phone/Fax

Practice location:
  • Phone: 918-921-9634
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: