Healthcare Provider Details

I. General information

NPI: 1407602899
Provider Name (Legal Business Name): MRS. VERENICE GASCA HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS VERENICE HERNANDEZ

II. Dates (important events)

Enumeration Date: 04/25/2024
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 S WESTERN AVE STE 105
OKLAHOMA CITY OK
73139-1816
US

IV. Provider business mailing address

10468 TURTLE BACK DR
MIDWEST CITY OK
73130-8244
US

V. Phone/Fax

Practice location:
  • Phone: 405-338-7674
  • Fax:
Mailing address:
  • Phone: 405-465-5152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: