Provider Demographics
NPI:1619529641
Name:AGBOGHAI, VICTORIA OMOLARA
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:OMOLARA
Last Name:AGBOGHAI
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 1:4613 WHITE OAK LN
Mailing Address - Street 2:
Mailing Address - City:OAK POINT
Mailing Address - State:TX
Mailing Address - Zip Code:75068-2095
Mailing Address - Country:US
Mailing Address - Phone:240-413-0112
Mailing Address - Fax:
Practice Address - Street 1:4613 WHITE OAK LN
Practice Address - Street 2:
Practice Address - City:OAK POINT
Practice Address - State:TX
Practice Address - Zip Code:75068-2095
Practice Address - Country:US
Practice Address - Phone:240-413-0112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-10
Last Update Date:2025-10-17
Deactivation Date:2020-05-19
Deactivation Code:
Reactivation Date:2025-10-17
Provider Licenses
StateLicense IDTaxonomies
TX1211228163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse