Basic Information
| Provider Information | |||||||||
| NPI: | 1093752925 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | QUIROZ | ||||||||
| FirstName: | LIESCHEN | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 920 SL YOUNG BLVD, WP 2430 | ||||||||
| Address2: | |||||||||
| City: | OKALHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731044313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052717449 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1122 NE 13TH ST | ||||||||
| Address2: | ORI 274B | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731171039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052711515 | ||||||||
| FaxNumber: | 4052711001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2006 | ||||||||
| LastUpdateDate: | 10/21/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | D62954 | MD | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207VF0040X | 26218 | OK | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Female Pelvic Medicine and Reconstructive Surgery |
ID Information
| ID | Type | State | Issuer | Description | 408412800 | 05 | MD | MEDICAID |