# PRIDE PLAZA MEDICAL LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Stephens Johnny J Member
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790773430
- **Authorized official:** DR. JAMES MWAKITAWA MWATIBO MD, PHD (PARTNER/MD)
- **Authorized official phone:** (337) 233-2115

## Contact information

- **Practice address:** 850 N PIERCE STREET, SUITE D, LAFAYETTE, LA 70501-2848
- **Practice address phone:** (337) 233-2115
- **Practice address fax:** (337) 237-9075
- **Mailing address:** 850 N PIERCE STREET, SUITE D, LAFAYETTE, LA 70501-2848
- **Mailing address phone:** (337) 233-2115
- **Mailing address fax:** (337) 237-9075

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |

## Other

- **Enumeration date:** 10/06/2005
- **Last updated:** 10/07/2010