MEDICARE: SHIJUANA OBI, LLC

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	261QA0006X	Ambulatory Fertility Facility

General Provider Information

NPI Number	:	1285204974
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHIJUANA OBI, LLC

Provider Business Mailing Address
First Line	:	5365 S DURANGO DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-2500
Country	:	US
Telephone Number	:	702-254-1777
Fax Number	:

Provider Business Practice Location Address
First Line	:	5365 S DURANGO DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-2500
Country	:	US
Telephone Number	:	702-254-1777
Fax Number	:

Authorized Official
Title or Position	:	CRNA
Name	:	MRS. SHIJUANA OBI
Credential	:	CRNA
Telephone Number	:	803-530-6596

Provider Enumeration Date	:	06/25/2021
Last Update Date	:	02/24/2026

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Directions to “SHIJUANA OBI, LLC ” Practice Location

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