# CENTRO PEDIATRICO STACHOLY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1932923182
- **Authorized official:** MARIELA STACHOLY MD (OWNER)
- **Authorized official phone:** (787) 872-1100

## Contact information

- **Practice address:** 24 CALLE CORONEL, ISABELA, PR 00662-4800
- **Practice address phone:** (787) 872-1100
- **Mailing address:** PO BOX 102, SAN ANTONIO, PR 00690-0102
- **Mailing address phone:** (939) 644-1122

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 11/14/2024
- **Last updated:** 11/14/2024