Provider Demographics
NPI:1194900324
Name:STELLAR MEDICAL MANAGEMENT, INC.
Entity type:Organization
Organization Name:STELLAR MEDICAL MANAGEMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:INEZ
Authorized Official - Middle Name:E
Authorized Official - Last Name:STELLAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-340-5545
Mailing Address - Street 1:39700 BOB HOPE DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-7103
Mailing Address - Country:US
Mailing Address - Phone:760-340-5545
Mailing Address - Fax:760-346-6208
Practice Address - Street 1:39700 BOB HOPE DR
Practice Address - Street 2:SUITE 110
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-7103
Practice Address - Country:US
Practice Address - Phone:760-340-5545
Practice Address - Fax:760-346-6208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty