Individual
VICTOR N FOMBO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
1333 W MCDERMOTT DR STE 150, ALLEN, TX 75013-3088
(214) 744-3361
Mailing address
9841 SHALLOW CREEK DR, WACO, TX 76708-6199
(254) 495-1804
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
24179378
VA
Other
Enumeration date
10/06/2020
Last updated
10/06/2020
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