Active NPI
Rebecca Agboruche
- Physician Assistant
- Dallas, TX
National Provider Identifier
1265201651
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 5601012166
- Practice address
- 4055 Valley View LN Ste 700
Dallas, TX 75244-5045 - Phone
- (855) 984-5121
- NPI assigned
- Dec 27, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 5601012166 | MI | Primary |
Addresses
Primary practice location
4055 Valley View LN Ste 700
Dallas, TX 75244-5045
Mailing address
15770 Vaughan St
Detroit, MI 48223-1249
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5601012166 | MI | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1703635200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1703635200000",
"number": "1265201651",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15770 VAUGHAN ST",
"city": "DETROIT",
"state": "MI",
"postal_code": "482231249"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4055 VALLEY VIEW LN STE 700",
"city": "DALLAS",
"state": "TX",
"postal_code": "752445045",
"telephone_number": "855-984-5121"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AGBORUCHE",
"first_name": "REBECCA",
"name_prefix": "Ms.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-12-27",
"last_updated": "2023-12-27",
"certification_date": "2023-12-27",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MI",
"license": "5601012166",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.