Provider Demographics
NPI:1821603739
Name:STELLA DEL MARE, LLC
Entity Type:Organization
Organization Name:STELLA DEL MARE, LLC
Other - Org Name:MARIAN HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:XAVIER
Authorized Official - Middle Name:ROMEO
Authorized Official - Last Name:RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-767-9039
Mailing Address - Street 1:2804 NE 8TH ST STE 103
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-5613
Mailing Address - Country:US
Mailing Address - Phone:305-901-0585
Mailing Address - Fax:305-901-0523
Practice Address - Street 1:2804 NE 8TH ST STE 103
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-5613
Practice Address - Country:US
Practice Address - Phone:305-901-0585
Practice Address - Fax:305-901-0523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-09
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL115955000Medicaid