Individual
LUIS ENRIQUE DIEZ AVILA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
4021 S WALKER AVE STE 201, OKLAHOMA CITY, OK 73109-6977
(405) 632-6688
Mailing address
3000 N GRAND BLVD, OKLAHOMA CITY, OK 73107-1818
(405) 632-6688
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
5020
OK
363AM0700X
Medical Physician Assistant
5562
SC
Other
Enumeration date
05/23/2023
Last updated
05/07/2025
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