MEDICARE: MRS. STELLA OBIAGERI KPADUWA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	A056261	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992872550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STELLA OBIAGERI KPADUWA M.D.

Provider Business Mailing Address
First Line	:	15913 AMAR RD
Second Line	:
City	:	LA PUENTE
State	:	CA
Zip	:	91744-2200
Country	:	US
Telephone Number	:	626-330-9535
Fax Number	:	626-330-2661

Provider Business Practice Location Address
First Line	:	16008 AMAR ROAD
Second Line	:
City	:	CITY OF INDUSTRY
State	:	CA
Zip	:	91744-2203
Country	:	US
Telephone Number	:	626-330-9535
Fax Number	:	626-330-2661

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	03/15/2018

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