Provider Demographics
NPI:1215474523
Name:KOSOKO, VICTORIA IYABODE
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:IYABODE
Last Name:KOSOKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14800 4TH ST
Mailing Address - Street 2:APT 73D
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-3764
Mailing Address - Country:US
Mailing Address - Phone:240-360-9783
Mailing Address - Fax:
Practice Address - Street 1:3811 MINNESOTA AVE NE
Practice Address - Street 2:WASHINGTON
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-2660
Practice Address - Country:US
Practice Address - Phone:240-581-2070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA12622374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide