Healthcare Provider Details

I. General information

NPI: 1407596547
Provider Name (Legal Business Name): VICTOR E. ONODJACHA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7616 BRANDON PL STE 220
SUGAR LAND TX
77479
US

IV. Provider business mailing address

4830 SILVERLAKE DR
SUGAR LAND TX
77479-5252
US

V. Phone/Fax

Practice location:
  • Phone: 208-473-1881
  • Fax: 582-998-2896
Mailing address:
  • Phone: 208-473-1881
  • Fax: 582-998-2896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1158721
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number60121
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: