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General NPI Number Information
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NPI Number | 1932923182
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Entity Type | Organization
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Legal Business Name | CENTRO PEDIATRICO STACHOLY LLC
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Dates
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Enumeration Date | 11/14/2024
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Last Update Date | 11/14/2024
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Provider Practice Location Address
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Address Line | 24 CALLE CORONEL
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City | ISABELA
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State | PR
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Zip | 00662-4800
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Country | US
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Telephone | 787-872-1100
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 102
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City | SAN ANTONIO
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State | PR
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Zip | 00690-0102
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Country | US
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Telephone | 939-644-1122
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARIELA STACHOLY
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Credential | MD
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Telephone | 787-872-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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