Provider Demographics
NPI:1659824456
Name:ALAGUGURUSAMY, VIRGINIA (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:ALAGUGURUSAMY
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6560 FANNIN ST
Mailing Address - Street 2:SUITE 1404
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2761
Mailing Address - Country:US
Mailing Address - Phone:713-441-5155
Mailing Address - Fax:
Practice Address - Street 1:6560 FANNIN ST STE 1404
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2706
Practice Address - Country:US
Practice Address - Phone:713-441-5155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP131541363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX362779602Medicaid
TX8540NYOtherBCBS
TX8539NYOtherBCBS
TX362779602Medicaid
TX530807YMVQMedicare PIN