MEDICARE: VICTORIA OKPALA

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	208D00000X	General Practice Physician	33149	OK

General Provider Information

NPI Number	:	1881052793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA OKPALA

Provider Business Mailing Address
First Line	:	360065 SANTA FE AVENUE
Second Line	:
City	:	FORT HOOD
State	:	TX
Zip	:	76544
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	BLDG 9424 BATTALION AVE
Second Line	:
City	:	APO
State	:	AA
Zip	:	76544
Country	:	US
Telephone Number	:	254-287-6147
Fax Number	:

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

Provider Enumeration Date	:	02/05/2016
Last Update Date	:	09/07/2017

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Directions to “ VICTORIA OKPALA ” Practice Location

Language	Start Address	Practice Location

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