Healthcare Provider Details

I. General information

NPI: 1053549196
Provider Name (Legal Business Name): LORENE NICOLE RODRIGUEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LORENE NICOLE AVNAIM M.D.

II. Dates (important events)

Enumeration Date: 06/28/2009
Last Update Date: 08/16/2024
Certification Date: 08/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 HEALTHPLEX PKWY
NORMAN OK
73072-9749
US

IV. Provider business mailing address

PO BOX 1330
NORMAN OK
73070-1330
US

V. Phone/Fax

Practice location:
  • Phone: 405-515-1000
  • Fax:
Mailing address:
  • Phone: 405-307-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number071276
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number071276
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA132793
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: