Provider Demographics
NPI:1164095485
Name:LABELLARTE-GUERRERO, STELLA MICHELE (X-RAY TECHNICIAN)
Entity Type:Individual
Prefix:
First Name:STELLA
Middle Name:MICHELE
Last Name:LABELLARTE-GUERRERO
Suffix:
Gender:F
Credentials:X-RAY TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 N TUSTIN AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3606
Mailing Address - Country:US
Mailing Address - Phone:714-835-7260
Mailing Address - Fax:
Practice Address - Street 1:720 N TUSTIN AVE STE 204
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3606
Practice Address - Country:US
Practice Address - Phone:714-835-7260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARHP00089307126900000X, 292200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes292200000XLaboratoriesDental Laboratory
No126900000XDental ProvidersDental Laboratory Technician