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General NPI Number Information
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NPI Number | 1972696979
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Entity Type | Organization
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Legal Business Name | MILDRED S ESTRELLA
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 04/19/2012
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Provider Practice Location Address
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Address Line | CARR. 172 KM 6.1 SECTOR LA SIERRA BO. CANABONCITO
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City | CAGUAS
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State | PR
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Zip | 00725-1876
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Country | US
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Telephone | 787-286-0065
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Fax | 787-286-0065
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Provider Business Mailing Address
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Address Line | P O BOX 4952 STE 487
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City | CAGUAS
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State | PR
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Zip | 00726-4952
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Country | US
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Telephone | 787-286-0065
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Fax | 787-286-0065
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Authorized Official
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Title or Position | OWNER
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Name | MILDRED S ESTRELLA
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Credential |
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Telephone | 787-286-0065
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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