Provider Demographics
NPI:1619546520
Name:IGBOAMAZU, CHRISTIAN UCHENNA PRINCE (CPC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:UCHENNA PRINCE
Last Name:IGBOAMAZU
Suffix:
Gender:M
Credentials:CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2112 INTERBAY ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-6502
Mailing Address - Country:US
Mailing Address - Phone:702-219-5283
Mailing Address - Fax:
Practice Address - Street 1:2915 W CHARLESTON BLVD # 175
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1939
Practice Address - Country:US
Practice Address - Phone:702-823-3910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-24
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health