Provider Demographics
NPI:1710755731
Name:VICTOR, VANDHANA FREDY (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:VANDHANA
Middle Name:FREDY
Last Name:VICTOR
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1140 BUSINESS CENTER DR STE 300
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77043-2742
Mailing Address - Country:US
Mailing Address - Phone:281-944-3610
Mailing Address - Fax:
Practice Address - Street 1:1140 BUSINESS CENTER DR STE 300
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77043-2742
Practice Address - Country:US
Practice Address - Phone:281-944-3610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-19
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant