Healthcare Provider Details

I. General information

NPI: 1861312613
Provider Name (Legal Business Name): OBADIAH JUAN RANGEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8790 F ST
OMAHA NE
68127-1524
US

IV. Provider business mailing address

8790 F ST
OMAHA NE
68127-1524
US

V. Phone/Fax

Practice location:
  • Phone: 402-904-2612
  • Fax:
Mailing address:
  • Phone: 402-981-2612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License NumberH14373043
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: