Provider Demographics
NPI:1134886526
Name:AUTAUBO, TAYANA MARIE
Entity type:Individual
Prefix:
First Name:TAYANA
Middle Name:MARIE
Last Name:AUTAUBO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TAYA
Other - Middle Name:MARIE
Other - Last Name:AUTAUBO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1055 S HOUSTON AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74127-9043
Mailing Address - Country:US
Mailing Address - Phone:918-921-3200
Mailing Address - Fax:
Practice Address - Street 1:1055 S HOUSTON AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74127-9043
Practice Address - Country:US
Practice Address - Phone:918-921-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-21
Last Update Date:2021-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator