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General NPI Number Information
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NPI Number | 1659008225
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Entity Type | Organization
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Legal Business Name | STELLAR INTERNAL MEDICINE LLC
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Dates
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Enumeration Date | 08/04/2022
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Last Update Date | 09/14/2022
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Provider Practice Location Address
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Address Line | 82282 HIGHWAY 1082
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City | BUSH
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State | LA
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Zip | 70431-2564
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Country | US
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Telephone | 985-789-4302
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Fax |
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Provider Business Mailing Address
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Address Line | 82282 HIGHWAY 1082
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City | BUSH
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State | LA
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Zip | 70431-2564
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Country | US
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Telephone | 985-789-4302
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. JESSICA GONZALEZ
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Credential | MD
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Telephone | 985-789-4302
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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