Provider Demographics
NPI:1972644383
Name:STAR HEALTH SERVICES CSP
Entity type:Organization
Organization Name:STAR HEALTH SERVICES CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ-DEL VALLE
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:787-764-0473
Mailing Address - Street 1:CALLE MAYAGUEZ NUM 52
Mailing Address - Street 2:URB. PEREZ MORRIS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919
Mailing Address - Country:US
Mailing Address - Phone:787-764-0473
Mailing Address - Fax:787-764-0482
Practice Address - Street 1:CALLE MAYAGUEZ NUM 52
Practice Address - Street 2:URB. PEREZ MORRIS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00919
Practice Address - Country:US
Practice Address - Phone:787-764-0473
Practice Address - Fax:787-764-0482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261QC1800X
261QC1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health