Provider Demographics
NPI:1831793389
Name:AKHIDENOR, VICTOR (PHD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:
Last Name:AKHIDENOR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:MISS
Other - First Name:EDEWEDE
Other - Middle Name:V
Other - Last Name:AKHIDENOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8124 MODESTO DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76001-8545
Mailing Address - Country:US
Mailing Address - Phone:281-989-8293
Mailing Address - Fax:682-222-7277
Practice Address - Street 1:8124 MODESTO DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76001-8545
Practice Address - Country:US
Practice Address - Phone:281-989-8293
Practice Address - Fax:682-222-7277
Is Sole Proprietor?:No
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator