Provider Demographics
NPI:1740371129
Name:SEBASTIAN, VERONIQUE (MD)
Entity type:Individual
Prefix:
First Name:VERONIQUE
Middle Name:
Last Name:SEBASTIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12800 CASTLEROCK CT
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73142-5127
Mailing Address - Country:US
Mailing Address - Phone:405-245-5646
Mailing Address - Fax:405-755-5802
Practice Address - Street 1:4140 W MEMORIAL RD
Practice Address - Street 2:#221
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8366
Practice Address - Country:US
Practice Address - Phone:405-755-5801
Practice Address - Fax:405-755-5939
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2019-05-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK208792084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK800522305Medicare PIN