# STATE OF OKLAHOMA MEDICAL CENTER LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1740177401
- **Authorized official:** CRISTINE HERNANDEZ (CEO)
- **Authorized official phone:** (510) 456-8143

## Contact information

- **Practice address:** 101 PARK AVE STE 1300, OKLAHOMA CITY, OK 73102-7216
- **Practice address phone:** (510) 456-8143
- **Mailing address:** 4570 S EASTERN AVE STE 28, LAS VEGAS, NV 89119-6183

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2084B0040X | Behavioral Neurology & Neuropsychiatry Physician | — | NULL | — |
| 2084B0040X | Behavioral Neurology & Neuropsychiatry Physician | — | — | — |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/23/2025
- **Last updated:** 06/23/2025