Individual
CRISTIAN LEE HERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
526 SW 4TH ST STE 200, MOORE, OK 73160-5409
(405) 759-2700
Mailing address
5205 GAINES ST, OKLAHOMA CITY, OK 73135-1427
(405) 404-5042
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
3266
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3266
MEDICAL LICENSE NUMBER
OK
Enumeration date
08/29/2022
Last updated
08/29/2022
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