MEDICARE: MRS. VERENICE GASCA HERNANDEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician		OK
2	171M00000X	Case Manager/Care Coordinator		OK

General Provider Information

NPI Number	:	1407602899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VERENICE GASCA HERNANDEZ

Provider Business Mailing Address
First Line	:	10468 TURTLE BACK DR
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73130-8244
Country	:	US
Telephone Number	:	405-465-5152
Fax Number	:

Provider Business Practice Location Address
First Line	:	6801 S WESTERN AVE STE 105
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-1816
Country	:	US
Telephone Number	:	405-338-7674
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2024
Last Update Date	:	12/11/2025

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