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General NPI Number Information
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NPI Number | 1427740075
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Entity Type | Individual
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Provider Name | LUIS ENRIQUE DIEZ AVILA PA-C
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Gender | Male
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Dates
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Enumeration Date | 05/23/2023
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 4021 S WALKER AVE STE 201
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City | OKLAHOMA CITY
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State | OK
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Zip | 73109-6977
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Country | US
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Telephone | 405-632-6688
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Fax |
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Provider Business Mailing Address
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Address Line | 3000 N GRAND BLVD
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City | OKLAHOMA CITY
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State | OK
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Zip | 73107-1818
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Country | US
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Telephone | 405-632-6688
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 5562
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 5020
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License Number State | OK
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