Provider Demographics
NPI:1770900904
Name:ENCHAUTEGUI COLON, YAZMIN (MD)
Entity type:Individual
Prefix:DR
First Name:YAZMIN
Middle Name:
Last Name:ENCHAUTEGUI COLON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 STANTON L YOUNG BLVD # 2410
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-5036
Mailing Address - Country:US
Mailing Address - Phone:405-271-4211
Mailing Address - Fax:405-271-2263
Practice Address - Street 1:1200 CHILDRENS AVE # 5D
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-4637
Practice Address - Country:US
Practice Address - Phone:405-271-4211
Practice Address - Fax:405-271-2263
Is Sole Proprietor?:No
Enumeration Date:2014-03-26
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18754207R00000X
FLME129070207SG0201X
CODR.0056958207SG0201X
OK35335207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018670800Medicaid
CO028940OtherKAISER COMMERCIAL NUMBER