Individual
SAN JUANITA SILVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FSP
Contact information
Practice address
604 CHRIS AVE, ALTUS, OK 73521-2305
(580) 301-0746
Mailing address
604 CHRIS AVE, ALTUS, OK 73521-2305
(580) 301-0746
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Enumeration date
08/27/2012
Last updated
02/20/2014
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