Basic Information
Provider Information | |||||||||
NPI: | 1215999248 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | NNADI | ||||||||
FirstName: | VICTORIA | ||||||||
MiddleName: | O | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1504 TAUB LOOP | ||||||||
Address2: |   | ||||||||
City: | HOUSTON | ||||||||
State: | TX | ||||||||
PostalCode: | 770301608 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7137981750 | ||||||||
FaxNumber: | 7137984693 | ||||||||
Practice Location | |||||||||
Address1: | 1504 TAUB LOOP | ||||||||
Address2: |   | ||||||||
City: | HOUSTON | ||||||||
State: | TX | ||||||||
PostalCode: | 770301608 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7137981750 | ||||||||
FaxNumber: | 7137984693 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/05/2006 | ||||||||
LastUpdateDate: | 05/24/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 05/24/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 200600940 | NC | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207R00000X | 0101230971 | VA | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207R00000X | TP978 | KY | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207R00000X | 49346 | KY | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207R00000X | S3266 | TX | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 407822201 | 05 | TX |   | MEDICAID | 407822203 | 05 | TX |   | MEDICAID | 5904370 | 05 | NC |   | MEDICAID | 407822202 | 05 | TX |   | MEDICAID | 7100477810 | 05 | KY |   | MEDICAID |