Healthcare Provider Details

I. General information

NPI: 1770130239
Provider Name (Legal Business Name): LA LUZ ORGANIZATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2019
Last Update Date: 08/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 N HUDSON AVE
OKLAHOMA CITY OK
73103-3918
US

IV. Provider business mailing address

PO BOX 864
OKLAHOMA CITY OK
73101-0864
US

V. Phone/Fax

Practice location:
  • Phone: 405-552-1041
  • Fax:
Mailing address:
  • Phone: 405-724-8474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: JAYRA CAMARENA
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 405-724-8474