Provider Demographics
NPI:1992872550
Name:KPADUWA, STELLA OBIAGERI (MD)
Entity type:Individual
Prefix:MRS
First Name:STELLA
Middle Name:OBIAGERI
Last Name:KPADUWA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15913 AMAR RD
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91744-2200
Mailing Address - Country:US
Mailing Address - Phone:626-330-9535
Mailing Address - Fax:626-330-2661
Practice Address - Street 1:16008 AMAR ROAD
Practice Address - Street 2:
Practice Address - City:CITY OF INDUSTRY
Practice Address - State:CA
Practice Address - Zip Code:91744-2203
Practice Address - Country:US
Practice Address - Phone:626-330-9535
Practice Address - Fax:626-330-2661
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA056261208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0085700Medicaid
7324532Medicare UPIN