| C Divine Llc | |
|
14406 Parkesgate Dr Houston TX 77083-5789 | |
| (832) 212-4739 | |
| Not Available |
| Full Name | C Divine Llc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 14406 Parkesgate Dr, Houston, Texas |
| Authorized Official Name and Position | Emiliana Ezechigbo (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 8322124739 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| C Divine Llc 14406 Parkesgate Dr Houston TX 77083-5789 Ph: () - | C Divine Llc 14406 Parkesgate Dr Houston TX 77083-5789 Ph: (832) 212-4739 |
| NPI Number | 1952950289 |
|---|---|
| Provider Enumeration Date | 09/09/2019 |
| Last Update Date | 02/06/2024 |
| Medicare PECOS PAC ID | 6103252523 |
|---|---|
| Medicare Enrollment ID | O20200204000294 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952950289 | NPI | - | NPPES |
| AP128425 | Other | TX | LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Primary |
| Provider Name | Emiliana O Ezechigbo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114385762 PECOS PAC ID: 3476829771 Enrollment ID: I20200204000429 |
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