Provider Demographics
NPI:1972696979
Name:MILDRED S ESTRELLA
Entity Type:Organization
Organization Name:MILDRED S ESTRELLA
Other - Org Name:LABORATORIO CLINICO ESTRELLA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MILDRED
Authorized Official - Middle Name:S
Authorized Official - Last Name:ESTRELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-286-0065
Mailing Address - Street 1:P O BOX 4952
Mailing Address - Street 2:STE 487
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-4952
Mailing Address - Country:US
Mailing Address - Phone:787-286-0065
Mailing Address - Fax:787-286-0065
Practice Address - Street 1:CARR. 172 KM 6.1 SECTOR LA SIERRA
Practice Address - Street 2:BO. CANABONCITO
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-1876
Practice Address - Country:US
Practice Address - Phone:787-286-0065
Practice Address - Fax:787-286-0065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0031133Medicare PIN