=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477341287
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HARMONY WELLNESS CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/30/2025
-----------------------------------------------------
Last Update Date | 04/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 411 NW 7TH ST STE 115
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73102-2810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-445-2060
-----------------------------------------------------
Fax | 210-800-9921
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 411 NW 7TH ST STE 115
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73102-2810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-445-2060
-----------------------------------------------------
Fax | 210-800-9921
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ANDY GONZALES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 405-445-2060
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------