Healthcare Provider Details

I. General information

NPI: 1316865405
Provider Name (Legal Business Name): CHRISTINA ISABELLE VELASCO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 S WESTERN AVE
OKLAHOMA CITY OK
73139-1817
US

IV. Provider business mailing address

9233 SW 48TH TER
OKLAHOMA CITY OK
73179-9707
US

V. Phone/Fax

Practice location:
  • Phone: 405-338-7674
  • Fax:
Mailing address:
  • Phone: 405-922-3166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: