Healthcare Provider Details

I. General information

NPI: 1093429193
Provider Name (Legal Business Name): CHRISTABEL OBUSEH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2023
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 SAMUELL BLVD STE 120
DALLAS TX
75228-7100
US

IV. Provider business mailing address

9637 FOREST LN APT 533
DALLAS TX
75243-0921
US

V. Phone/Fax

Practice location:
  • Phone: 214-381-1910
  • Fax:
Mailing address:
  • Phone: 980-365-0844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA66263
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA16846
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: