Provider Demographics
NPI:1710335260
Name:RAYGOZA, EVELYN KARINA (CM1)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:KARINA
Last Name:RAYGOZA
Suffix:
Gender:F
Credentials:CM1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2845 SW 79TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-4705
Mailing Address - Country:US
Mailing Address - Phone:405-664-9183
Mailing Address - Fax:
Practice Address - Street 1:2845 SW 79TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-4705
Practice Address - Country:US
Practice Address - Phone:405-664-9183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator