Healthcare Provider Details

I. General information

NPI: 1265939276
Provider Name (Legal Business Name): CHRISTIAN IBANEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2018
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23910 KATY FWY STE 201
KATY TX
77494-1477
US

IV. Provider business mailing address

6400 FANNIN ST STE 1700
HOUSTON TX
77030-1526
US

V. Phone/Fax

Practice location:
  • Phone: 713-486-9800
  • Fax: 281-392-3666
Mailing address:
  • Phone: 713-486-7500
  • Fax: 713-512-7240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberU9972
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: