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General NPI Number Information
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NPI Number | 1164095485
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Entity Type | Individual
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Provider Name | STELLA MICHELE LABELLARTE-GUERRERO X-RAY TECHNICIAN
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Gender | Female
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Dates
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Enumeration Date | 07/23/2021
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Last Update Date | 07/23/2021
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Provider Practice Location Address
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Address Line | 720 N TUSTIN AVE STE 204
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City | SANTA ANA
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State | CA
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Zip | 92705-3606
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Country | US
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Telephone | 714-835-7260
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Fax |
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Provider Business Mailing Address
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Address Line | 720 N TUSTIN AVE STE 204
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City | SANTA ANA
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State | CA
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Zip | 92705-3606
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Country | US
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Telephone | 714-835-7260
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 126900000X
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Taxonomy Name | Dental Laboratory Technician
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License Number | RHP00089307
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 292200000X
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Taxonomy Name | Dental Laboratory
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License Number | RHP00089307
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License Number State | CA
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