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General NPI Number Information
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NPI Number | 1619491891
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Entity Type | Organization
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Legal Business Name | STELLAE LLC
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Dates
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Enumeration Date | 07/31/2017
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Last Update Date | 07/31/2017
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Provider Practice Location Address
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Address Line | 8323 NW 12 STREET SUITE 115
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City | MIAMI
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State | FL
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Zip | 33126
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Country | US
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Telephone | 305-284-7484
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Fax |
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Provider Business Mailing Address
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Address Line | 8323 NW 12TH ST STE 115
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City | DORAL
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State | FL
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Zip | 33126-1839
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | RONNIE JOHNSON
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Credential |
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Telephone | 305-284-7484
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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