Individual
EVARISTUS EKENJUCK FOTINDONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
9210 S WESTERN AVE # A-21, OKLAHOMA CITY, OK 73139-4982
(405) 676-9227
Mailing address
5401 NW 36TH ST APT 3, OKLAHOMA CITY, OK 73122-2314
(405) 887-2215
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
OK
Other
Enumeration date
11/13/2020
Last updated
11/13/2020
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