Provider Demographics
NPI:1336808088
Name:AGASHI, STELLA IFESINACHI
Entity Type:Individual
Prefix:MRS
First Name:STELLA
Middle Name:IFESINACHI
Last Name:AGASHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1198 JEFFERSON ST APT 203
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-4501
Mailing Address - Country:US
Mailing Address - Phone:510-688-3288
Mailing Address - Fax:
Practice Address - Street 1:8471 ENTERPRISE WAY
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94621-1317
Practice Address - Country:US
Practice Address - Phone:408-625-7565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-09
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95195685163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse