Healthcare Provider Details

I. General information

NPI: 1356532386
Provider Name (Legal Business Name): VICTOR AZUBIKE AMOBI CRNP-PMH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 11/22/2021
Certification Date: 11/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 W 133RD ST
NEW YORK NY
10030-3301
US

IV. Provider business mailing address

2929 WOODLAND PARK DR
HOUSTON TX
77082-2687
US

V. Phone/Fax

Practice location:
  • Phone: 646-762-4950
  • Fax: 646-762-4955
Mailing address:
  • Phone: 713-589-4122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number679575
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberR178048
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number402802
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: