Provider Demographics
NPI:1063914927
Name:IGBOAMAZU, OYIBO
Entity type:Individual
Prefix:
First Name:OYIBO
Middle Name:
Last Name:IGBOAMAZU
Suffix:
Gender:F
Credentials:
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:702-327-9012
Mailing Address - Fax:
Practice Address - Street 1:6034 SMOKE RANCH RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-3700
Practice Address - Country:US
Practice Address - Phone:702-219-5283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-06
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV07436-LCJ101YA0400X
106H00000X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant