Provider Demographics
NPI:1306928684
Name:LABORATORIO CLINICO RODRIGUEZ STELLA INC
Entity type:Organization
Organization Name:LABORATORIO CLINICO RODRIGUEZ STELLA INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:MR
Authorized Official - First Name:DAMIAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:SANCHEZ IRIZARRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-808-4040
Mailing Address - Street 1:2610 MAYOR STREET
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-2074
Mailing Address - Country:US
Mailing Address - Phone:787-843-2251
Mailing Address - Fax:787-843-2251
Practice Address - Street 1:2610 MAYOR STREET
Practice Address - Street 2:SUITE 2
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-2074
Practice Address - Country:US
Practice Address - Phone:787-843-2251
Practice Address - Fax:787-843-2251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0428291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
38179Medicare ID - Type Unspecified