Provider Demographics
NPI:1023248333
Name:LABORATORIO CLINICO STELLA MIKAELA INC.
Entity type:Organization
Organization Name:LABORATORIO CLINICO STELLA MIKAELA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SEPULVEDA
Authorized Official - Suffix:
Authorized Official - Credentials:1361
Authorized Official - Phone:787-855-3060
Mailing Address - Street 1:PO BOX 4571
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00694-4571
Mailing Address - Country:US
Mailing Address - Phone:787-855-3060
Mailing Address - Fax:787-855-3060
Practice Address - Street 1:B10 CALLE 2
Practice Address - Street 2:VILLA REAL
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693-4557
Practice Address - Country:US
Practice Address - Phone:787-855-3060
Practice Address - Fax:787-855-3060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-21
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR642291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory