Provider Demographics
NPI:1770831695
Name:SILVA, SAN JUANITA (FSP)
Entity Type:Individual
Prefix:
First Name:SAN JUANITA
Middle Name:
Last Name:SILVA
Suffix:
Gender:F
Credentials:FSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 CHRIS AVE
Mailing Address - Street 2:
Mailing Address - City:ALTUS
Mailing Address - State:OK
Mailing Address - Zip Code:73521-2305
Mailing Address - Country:US
Mailing Address - Phone:580-301-0746
Mailing Address - Fax:
Practice Address - Street 1:604 CHRIS AVE
Practice Address - Street 2:
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521-2305
Practice Address - Country:US
Practice Address - Phone:580-301-0746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-27
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management