Individual
ASHLEY ALTAGRACIA BREA TAVAREZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
420 SW 10TH ST, OKLAHOMA CITY, OK 73109-5610
(405) 236-0701
Mailing address
9501 S I 35 SERVICE RD APT 519, MOORE, OK 73160-3146
(347) 995-7868
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
09/13/2019
Last updated
09/13/2019
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