Provider Demographics
NPI:1356965404
Name:SANJUANA CABALLERO D B A LOVELESS SHOES INC LLC
Entity type:Organization
Organization Name:SANJUANA CABALLERO D B A LOVELESS SHOES INC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANJUANA
Authorized Official - Middle Name:ROGACIANA
Authorized Official - Last Name:CABALLERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-412-8621
Mailing Address - Street 1:1899 SADDLEBACK BLVD APT 10
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-2857
Mailing Address - Country:US
Mailing Address - Phone:405-412-8621
Mailing Address - Fax:405-634-9717
Practice Address - Street 1:4901 W RENO AVE STE 800
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73127-6398
Practice Address - Country:US
Practice Address - Phone:405-631-9731
Practice Address - Fax:405-634-9717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthistGroup - Single Specialty