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Provider Information for 1902947120

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

DR. STELLA GRACE IMMANUEL MD

Other Name:   STELLA GWANDIKU-AMBE
Gender: FEMALE

Individual NPI: 1902947120

Calendar   Last Updated:  2019-11-22
  Certification Date: 

Details

Name Value
NPI 1902947120
Enumeration Date 2007-02-09
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 25231 ROESNER LN
KATY, TX 77494-5537
United States

Phone: 281-506-7412 | Fax: 281-530-2882
View Map External Link
Primary Practice Address 25231 ROESNER LN
KATY, TX 77494-5537
United States

Phone: 281-506-7412 | Fax: 281-530-2882
View Map External Link
Secondary Practice Address 6718 HIGHWAY 6 S
HOUSTON, TX 77083-1512
United States

Phone: 281-506-7412 | Fax: 281-530-2882
View Map External Link

Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 207Q00000X - Family Medicine TX S3994
No 2080A0000X - Pediatrics Adolescent Medicine TX S3994