Provider Demographics
NPI:1043055544
Name:ANDALUZ-BATES, MARINA RACHELLE (LM, CPM)
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:RACHELLE
Last Name:ANDALUZ-BATES
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6925 S CANTON AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3418
Mailing Address - Country:US
Mailing Address - Phone:918-932-8164
Mailing Address - Fax:
Practice Address - Street 1:6925 S CANTON AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-3418
Practice Address - Country:US
Practice Address - Phone:918-932-8164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-26
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKMIDW0051176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty