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General NPI Number Information
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NPI Number | 1437871779
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Entity Type | Individual
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Provider Name | EZY SIQUEIROS
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Gender | Female
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Dates
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Enumeration Date | 09/14/2022
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Last Update Date | 09/14/2022
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Provider Practice Location Address
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Address Line | 3124 E APACHE ST
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City | TULSA
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State | OK
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Zip | 74110-2320
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Country | US
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Telephone | 918-508-2717
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Fax | 918-508-2788
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Provider Business Mailing Address
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Address Line | 6941 S JOPLIN AVE APT 1210
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City | TULSA
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State | OK
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Zip | 74136-3541
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Country | US
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Telephone | 918-851-6937
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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