Organization
C DIVINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EMILIANA EZECHIGBO (CHIEF EXECUTIVE OFFICER)
(832) 212-4739
Entity
Organization
Contact information
Practice address
14406 PARKESGATE DR, HOUSTON, TX 77083-5789
(832) 212-4739
Mailing address
14406 PARKESGATE DR, HOUSTON, TX 77083-5789
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AP128425
LICENSE
TX
Enumeration date
09/09/2019
Last updated
02/06/2024
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