MEDICARE: VICTORIA AGUDAH NP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP140032	TX
2	363L00000X	Nurse Practitioner	AP140032	TX

General Provider Information

NPI Number	:	1730647991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA AGUDAH NP

Provider Business Mailing Address
First Line	:	4621 S COOPER ST STE 131-657
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76017-5866
Country	:	US
Telephone Number	:	817-899-8856
Fax Number	:

Provider Business Practice Location Address
First Line	:	4621 S COOPER ST STE 131-657
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76017-5866
Country	:	US
Telephone Number	:	817-899-8856
Fax Number	:

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

Provider Enumeration Date	:	03/06/2019
Last Update Date	:	08/17/2023

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