Healthcare Provider Details

I. General information

NPI: 1104175009
Provider Name (Legal Business Name): VICTOR OBIJURU NJOKU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2012
Last Update Date: 11/26/2021
Certification Date: 11/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10807 PERRIN BEITEL RD
SAN ANTONIO TX
78217-3143
US

IV. Provider business mailing address

10807 PERRIN BEITEL RD
SAN ANTONIO TX
78217-3143
US

V. Phone/Fax

Practice location:
  • Phone: 210-847-1486
  • Fax: 210-588-0006
Mailing address:
  • Phone: 210-847-1486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number22635
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberQ3254
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: