Provider Demographics
NPI:1902260565
Name:URQUIOLA SORZANO, JACLYN C (DO)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:C
Last Name:URQUIOLA SORZANO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9100 NW 117TH ST
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-8945
Mailing Address - Country:US
Mailing Address - Phone:786-390-6297
Mailing Address - Fax:
Practice Address - Street 1:940 NE 13TH ST # 2300
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5008
Practice Address - Country:US
Practice Address - Phone:405-271-2429
Practice Address - Fax:407-975-0413
Is Sole Proprietor?:No
Enumeration Date:2016-04-11
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS16013208000000X
390200000X
OK76102080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program