Provider Demographics
NPI:1790566966
Name:VICDOS HEALTH PLLC
Entity Type:Organization
Organization Name:VICDOS HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HERITAGE
Authorized Official - Middle Name:EWAOLUWA
Authorized Official - Last Name:OGUNMOLA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:317-607-5447
Mailing Address - Street 1:19179 BLANCO RD STE 105
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4009
Mailing Address - Country:US
Mailing Address - Phone:210-985-6886
Mailing Address - Fax:210-899-8013
Practice Address - Street 1:7750 CULEBRA RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-1468
Practice Address - Country:US
Practice Address - Phone:210-985-6886
Practice Address - Fax:210-899-8013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251J00000XAgenciesNursing Care
No171W00000XOther Service ProvidersContractorGroup - Multi-Specialty
No251E00000XAgenciesHome Health