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Oklahoma Board of Medical Licensure and Supervision

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Last Update: Thursday, December 19, 2024 3:44 AM CST
Next Update: Thursday, December 19, 2024 12:00 PM CST

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This verification service provides current data extracted by the Oklahoma State Board of Medical Licensure and Supervision (OSBMLS) from its own database. The data enclosed in the green box below is provided by and controlled entirely by the OSBMLS and therefore constitutes a primary source verification of licensure status as authentic as a direct inquiry to the OSBMLS. NPI# and hospital privileges (if any) are provided by the licensee and not verified.
Practice Address: 1510 SAN PABLO ST. STE. 322
LOS ANGELES CA 90033

Address last updated on 10/31/2023
Phone #:
Fax #:
County: NOT OKLAHOMA
License: 40547
Dated: 12/21/2022
Expires: 12/1/2024
License Type: Medical Doctor
Specialty: Cardiovascular Disease
Status: Inactive
Status Class: Expired License
Restricted to:
Registered to Dispense: NO
Medical School: Univ of TX Med Sch at Houston, Houston Tx 77225
Graduated: 6 / 2001
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.
Certifications: AMERICAN BOARD OF INTERNAL MEDICINE - Cardiovascular Disease
New Patients: Contact licensee
Medicaid: Contact licensee
Medicare: Contact licensee
   
HMO/PPO: None listed
Hospital Privileges: None listed
Locations: Hours: Languages:
1510 SAN PABLO ST. STE. 322
LOS ANGELES CA 90033

Phone #:
Fax #:
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Tue:
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