MEDICARE: OYIBO IGBOAMAZU

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	07436-LCJ	NV
2	106H00000X	Marriage & Family Therapist
3	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1063914927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OYIBO IGBOAMAZU

Provider Business Mailing Address
First Line	:	2112 INTERBAY ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-6502
Country	:	US
Telephone Number	:	702-327-9012
Fax Number	:

Provider Business Practice Location Address
First Line	:	6034 SMOKE RANCH RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-3700
Country	:	US
Telephone Number	:	702-219-5283
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2018
Last Update Date	:	06/15/2023

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Directions to “ OYIBO IGBOAMAZU ” Practice Location

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