MEDICARE: CHIQUITA CARBAJAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1952744013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHIQUITA CARBAJAL

Provider Business Mailing Address
First Line	:	1020 SW 101ST ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-2939
Country	:	US
Telephone Number	:	405-520-7634
Fax Number	:

Provider Business Practice Location Address
First Line	:	1020 SW 101ST ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-2939
Country	:	US
Telephone Number	:	405-520-7634
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2013
Last Update Date	:	04/09/2013

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