1972696979 NPI number — MILDRED S ESTRELLA

Table of content: (NPI 1972696979)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972696979 NPI number — MILDRED S ESTRELLA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MILDRED S ESTRELLA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LABORATORIO CLINICO ESTRELLA
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972696979
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P O BOX 4952
Provider Second Line Business Mailing Address:
STE 487
Provider Business Mailing Address City Name:
CAGUAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00726-4952
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-286-0065
Provider Business Mailing Address Fax Number:
787-286-0065

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR. 172 KM 6.1 SECTOR LA SIERRA
Provider Second Line Business Practice Location Address:
BO. CANABONCITO
Provider Business Practice Location Address City Name:
CAGUAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00725-1876
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-286-0065
Provider Business Practice Location Address Fax Number:
787-286-0065
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ESTRELLA
Authorized Official First Name:
MILDRED
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
787-286-0065

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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