Provider Demographics
NPI:1295867307
Name:STAR DIAGNOSTIC, TREATMENT & AMBULATORY SERVICES
Entity Type:Organization
Organization Name:STAR DIAGNOSTIC, TREATMENT & AMBULATORY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:
Authorized Official - First Name:LUCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-818-0600
Mailing Address - Street 1:1840 W 49TH ST
Mailing Address - Street 2:SUITE 311
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-2942
Mailing Address - Country:US
Mailing Address - Phone:305-818-0600
Mailing Address - Fax:305-818-0620
Practice Address - Street 1:1840 W 49TH ST
Practice Address - Street 2:SUITE 311
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2942
Practice Address - Country:US
Practice Address - Phone:305-818-0600
Practice Address - Fax:305-818-0620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC5605261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center