Provider Demographics
NPI:1447028436
Name:HIPOLITO, VICENTE
Entity type:Individual
Prefix:MR
First Name:VICENTE
Middle Name:
Last Name:HIPOLITO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 SWAN LAKE CT
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-4806
Mailing Address - Country:US
Mailing Address - Phone:405-664-6873
Mailing Address - Fax:
Practice Address - Street 1:400 N WALKER AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-1886
Practice Address - Country:US
Practice Address - Phone:405-652-9486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator