Healthcare Provider Details

I. General information

NPI: 1902618978
Provider Name (Legal Business Name): STELLA UZOAMAKA IHESIABA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2025
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9730 WESTOVER HILLS BLVD
SAN ANTONIO TX
78251-4841
US

IV. Provider business mailing address

9847 MARBACH BND
SAN ANTONIO TX
78245-1699
US

V. Phone/Fax

Practice location:
  • Phone: 210-366-3700
  • Fax:
Mailing address:
  • Phone: 210-300-0478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1189129
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: