Provider Demographics
NPI:1184047110
Name:FAIRES, VICTORIA GACAD (FNP-C)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:GACAD
Last Name:FAIRES
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MRS
Other - First Name:VICKY
Other - Middle Name:
Other - Last Name:FAIRES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, FNP-C
Mailing Address - Street 1:5420 BELLAIRE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-3957
Mailing Address - Country:US
Mailing Address - Phone:713-663-6322
Mailing Address - Fax:
Practice Address - Street 1:5420 BELLAIRE BLVD STE A
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-3957
Practice Address - Country:US
Practice Address - Phone:713-663-6322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-27
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX508108363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily