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Oklahoma Board of Medical Licensure and Supervision

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Last Update: Wednesday, May 15, 2024 4:04 AM CDT
Next Update: Wednesday, May 15, 2024 12:00 PM CDT

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DIEZ AVILA, LUIS ENRIQUE       
Practice Address: VARIETY CARE CLINIC
4021 S WALKER AVE #201
OKLAHOMA CITY OK 73109

Address last updated on 2/3/2024
Phone #: (405) 632-6688
Fax #:
County: OKLAHOMA
License: 5020
Dated: 6/16/2023
Expires: 3/31/2025
License Type: Physician Assistant
Specialty:
Status: Active
Status Class: Fully Licensed
Restricted to:
CME Year: 2025
Pending and/or Past Disciplinary Actions: No Disciplinary Action Taken.
All information below is entered by the licensee but not verified by the Oklahoma Medical Board.
Locations: Hours: Languages:
VARIETY CARE CLINIC
4021 S WALKER AVE #201
OKLAHOMA CITY OK 73109

Phone #: (405) 632-6688
Fax #:

Hospital Privileges:

None listed

Primary Supervisor(s):
Name: Type: License Number: Full/Part Time:
YADER ALBERTO MENDOZA GOMEZ MD 27194
SHELEATHA MICHELLE TAYLOR-BRISTOW MD 27765

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