Basic Information
| Provider Information | |||||||||
| NPI: | 1417216037 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NORIEGA | ||||||||
| FirstName: | RAMON | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13901 MCAULEY BLVD | ||||||||
| Address2: | STE 303 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731348704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052726358 | ||||||||
| FaxNumber: | 4052313007 | ||||||||
| Practice Location | |||||||||
| Address1: | 13901 MCAULEY BLVD STE 303 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 73134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057485800 | ||||||||
| FaxNumber: | 4057485806 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2012 | ||||||||
| LastUpdateDate: | 12/21/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | BP10055883 | TX | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207RN0300X | 6557 | OK | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.