Provider Demographics
NPI:1679389290
Name:CANJURA, OBED
Entity type:Individual
Prefix:
First Name:OBED
Middle Name:
Last Name:CANJURA
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 1:412 TELEPHONE RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77023-1840
Mailing Address - Country:US
Mailing Address - Phone:713-660-1880
Mailing Address - Fax:
Practice Address - Street 1:412 TELEPHONE RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77023-1840
Practice Address - Country:US
Practice Address - Phone:713-660-1880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12711172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker