Provider Demographics
NPI:1699308858
Name:OBIAJULU, RAYMOND C
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:C
Last Name:OBIAJULU
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 1:1911 WILLIAM LUSK RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-4741
Mailing Address - Country:US
Mailing Address - Phone:713-838-6352
Mailing Address - Fax:
Practice Address - Street 1:1911 WILLIAM LUSK RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-4741
Practice Address - Country:US
Practice Address - Phone:713-838-6352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-17
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP144677363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health