Healthcare Provider Details

I. General information

NPI: 1164095485
Provider Name (Legal Business Name): STELLA MICHELE LABELLARTE-GUERRERO X-RAY TECHNICIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2021
Last Update Date: 07/23/2021
Certification Date: 07/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 N TUSTIN AVE STE 204
SANTA ANA CA
92705-3606
US

IV. Provider business mailing address

720 N TUSTIN AVE STE 204
SANTA ANA CA
92705-3606
US

V. Phone/Fax

Practice location:
  • Phone: 714-835-7260
  • Fax:
Mailing address:
  • Phone: 714-835-7260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code292200000X
TaxonomyDental Laboratory
License NumberRHP00089307
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code126900000X
TaxonomyDental Laboratory Technician
License NumberRHP00089307
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: