Provider Demographics
NPI:1700770484
Name:AZUA, OBED
Entity type:Individual
Prefix:
First Name:OBED
Middle Name:
Last Name:AZUA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7216 COCO DR
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78574-0984
Mailing Address - Country:US
Mailing Address - Phone:956-651-5351
Mailing Address - Fax:
Practice Address - Street 1:7216 COCO DR
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78574-0984
Practice Address - Country:US
Practice Address - Phone:956-651-5351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications