Individual provider Active NPI

Carl Bruce Stater

  • Counselor
  • Escondido, CA
National Provider Identifier
1013085000
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
Practice address
474 W Vermont Ave Ste 104
Escondido, CA 92025-6584
Phone
(176) 043-2988
Fax
(176) 043-2995
NPI assigned
Nov 30, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X Primary

Addresses

Primary practice location

474 W Vermont Ave Ste 104
Escondido, CA 92025-6584

Mailing address

474 W Vermont Ave Ste 104
Escondido, CA 92025-6584
Phone (176) 043-2988

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1013085000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "474 W VERMONT AVE STE 104",
            "city": "ESCONDIDO",
            "state": "CA",
            "postal_code": "920256584",
            "telephone_number": "176-043-2988",
            "fax_number": "176-043-2995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "474 W VERMONT AVE STE 104",
            "city": "ESCONDIDO",
            "state": "CA",
            "postal_code": "920256584",
            "telephone_number": "176-043-2988",
            "fax_number": "176-043-2995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STATER",
        "first_name": "CARL",
        "middle_name": "BRUCE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Escondido, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.