Provider Demographics
NPI:1811127475
Name:NOBLEZA, CHRISTA O'HANA S (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTA O'HANA
Middle Name:S
Last Name:NOBLEZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CHRISTA O'HANA
Other - Middle Name:VILLANUEVA
Other - Last Name:SAN LUIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:965 RIDGE LAKE BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-9446
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:901-227-8591
Practice Address - Street 1:6019 WALNUT GROVE RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120
Practice Address - Country:US
Practice Address - Phone:901-226-4910
Practice Address - Fax:901-226-4915
Is Sole Proprietor?:No
Enumeration Date:2009-07-16
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS236962084A2900X, 2084N0400X
TN631112084N0400X, 2084A2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurocritical Care
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03438889Medicaid
AL189900Medicaid
MSP01555817OtherRR MEDICARE
MSP01555817OtherRR MEDICARE