Healthcare Provider Details

I. General information

NPI: 1356617369
Provider Name (Legal Business Name): CHRYSTAL NNENNA OBI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2012
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 W CHARLESTON BLVD
LAS VEGAS NV
89102-2386
US

IV. Provider business mailing address

1800 W CHARLESTON BLVD
LAS VEGAS NV
89102-2386
US

V. Phone/Fax

Practice location:
  • Phone: 702-383-2000
  • Fax:
Mailing address:
  • Phone: 702-383-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number26401
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberA127335
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number26401
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License NumberA127335
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberU8788
License Number StateTX
# 6
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA127335
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number26401
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: