Provider Demographics
NPI:1700581857
Name:ABOLARIN, VICTORIA ENEYI (NP)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ENEYI
Last Name:ABOLARIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13923 TRIBECA
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-4726
Mailing Address - Country:US
Mailing Address - Phone:832-744-9418
Mailing Address - Fax:
Practice Address - Street 1:8122 DATAPOINT DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3272
Practice Address - Country:US
Practice Address - Phone:210-616-0999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1114184363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health