Healthcare Provider Details

I. General information

NPI: 1982856548
Provider Name (Legal Business Name): SEBASTIAN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2008
Last Update Date: 10/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 W MEMORIAL SUITE 221
OKLAHOMA CITY OK
73120
US

IV. Provider business mailing address

12800 CASTLEROCK CT
OKLAHOMA CITY OK
73142-5127
US

V. Phone/Fax

Practice location:
  • Phone: 405-755-5801
  • Fax: 405-755-5949
Mailing address:
  • Phone: 405-751-2605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number20879
License Number StateOK

VIII. Authorized Official

Name: VERONIQUE SEBASTIAN
Title or Position: PRESIDENT
Credential: MD
Phone: 405-755-5801