Individual
LUIS ALFONSE JIMENEZ RINCON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3501 S 1ST ST, BROKEN ARROW, OK 74012-7916
(918) 813-3826
Mailing address
3501 S 1ST ST, BROKEN ARROW, OK 74012-7916
(918) 813-3826
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
171M00000X
OK
Other
Enumeration date
09/06/2013
Last updated
09/06/2013
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