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Organization
REHOBOTH MEDICAL CENTER LLC
Active
Organization
REHOBOTH MEDICAL CENTER LLC
Active
Other names
Rehoboth Pediatric Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
STELLA GRACE IMMANUEL MD (MEDICAL DIRECTOR)
(281) 506-7412
Entity
Organization
Contact information
Practice address
25231 ROESNER LN, KATY, TX 77494-5537
(281) 506-7412
(281) 530-2882
Mailing address
25231 ROESNER LN, KATY, TX 77494-5537
(281) 506-7412
(281) 530-2882
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
2080A0000X
Pediatric Adolescent Medicine Physician
—
—
Other
Enumeration date
11/21/2019
Last updated
11/21/2019
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