Provider Demographics
NPI:1669668133
Name:AGBAROJI, VICTORIA (RN)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:AGBAROJI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 DALTON DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-4454
Mailing Address - Country:US
Mailing Address - Phone:972-274-6922
Mailing Address - Fax:972-274-6932
Practice Address - Street 1:215 DALTON DR
Practice Address - Street 2:SUITE D
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-4454
Practice Address - Country:US
Practice Address - Phone:972-274-6922
Practice Address - Fax:972-274-6932
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX569877163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse