Healthcare Provider Details

I. General information

NPI: 1972416378
Provider Name (Legal Business Name): CHRISTOPHER JOHN AGBAYANI MABAZZA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 S LINCOLNWAY STE 120
NORTH AURORA IL
60542-1659
US

IV. Provider business mailing address

161 S LINCOLNWAY
NORTH AURORA IL
60542-1658
US

V. Phone/Fax

Practice location:
  • Phone: 630-859-2504
  • Fax: 708-202-5443
Mailing address:
  • Phone: 630-859-2504
  • Fax: 708-202-5443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number877747
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.366977
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: