Provider Demographics
NPI:1710516505
Name:MAGUWUDZE, STELLA RUFARO (MD)
Entity Type:Individual
Prefix:
First Name:STELLA
Middle Name:RUFARO
Last Name:MAGUWUDZE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2770 W DEVONSHIRE AVE APT E15
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92545-5028
Mailing Address - Country:US
Mailing Address - Phone:661-666-7893
Mailing Address - Fax:
Practice Address - Street 1:1117 E DEVONSHIRE AVE # CA
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-3083
Practice Address - Country:US
Practice Address - Phone:951-765-4848
Practice Address - Fax:951-791-4380
Is Sole Proprietor?:No
Enumeration Date:2020-04-03
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA190259208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program