Organization
STATE OF OKLAHOMA MEDICAL CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRISTINE HERNANDEZ (CEO)
(510) 456-8143
Entity
Organization
Contact information
Practice address
101 PARK AVE STE 1300, OKLAHOMA CITY, OK 73102-7216
(510) 456-8143
Mailing address
4570 S EASTERN AVE STE 28, LAS VEGAS, NV 89119-6183
Taxonomy
Speciality
Code
Description
License number
State
2084B0040X
Behavioral Neurology & Neuropsychiatry Physician
—
—
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
06/23/2025
Last updated
06/23/2025
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