MEDICARE: VICTORIA AGBAROJI RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	569877	TX

General Provider Information

NPI Number	:	1669668133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA AGBAROJI RN

Provider Business Mailing Address
First Line	:	215 DALTON DR
Second Line	:	SUITE D
City	:	DESOTO
State	:	TX
Zip	:	75115-4454
Country	:	US
Telephone Number	:	972-274-6922
Fax Number	:	972-274-6932

Provider Business Practice Location Address
First Line	:	215 DALTON DR
Second Line	:	SUITE D
City	:	DESOTO
State	:	TX
Zip	:	75115-4454
Country	:	US
Telephone Number	:	972-274-6922
Fax Number	:	972-274-6932

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2007
Last Update Date	:	06/12/2013

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