=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841187267
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAMIRO CRUZ
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/19/2025
-----------------------------------------------------
Last Update Date | 06/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1111 W 17TH ST
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74107-1886
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-582-1972
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 204 E AVENUE C
-----------------------------------------------------
City | HEAVENER
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74937-2641
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-571-6708
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------