Provider Demographics
NPI:1760887335
Name:OBIOMA, CHRISTIAN N
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:N
Last Name:OBIOMA
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 1:1209 AFGHAN PATH
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-3439
Mailing Address - Country:US
Mailing Address - Phone:512-775-7225
Mailing Address - Fax:
Practice Address - Street 1:14205 BURNET RD
Practice Address - Street 2:SUITE 330
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78728-6527
Practice Address - Country:US
Practice Address - Phone:512-775-7225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-25
Last Update Date:2014-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1949144171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor