Stateside Medical LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

STATESIDE MEDICAL LLC

Practice address

380 W Baseline Rd
Claremont, CA 91711-1751

Phone

(714) 408-8996

NPI assigned

Mar 3, 2020

Organization subpart

No

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

Authorized official

Name

Toby Miclat

Title

Administrator

Phone

(714) 408-8996

Specialties & licenses 1

Addresses

Tax ID family

Stateside Medical LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Stateside Medical LLC

  • Assisted Living Facility
  • Upland, CA
  • NPI 1952936312
  NPD tax ID

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

{
    "created_epoch": "1583193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583193600000",
    "number": "1215562913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1920 N INDIAN HILL BLVD",
            "city": "CLAREMONT",
            "state": "CA",
            "postal_code": "917112721",
            "telephone_number": "714-408-8996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "380 W BASELINE RD",
            "city": "CLAREMONT",
            "state": "CA",
            "postal_code": "917111751",
            "telephone_number": "714-408-8996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATESIDE MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-03",
        "last_updated": "2020-03-03",
        "certification_date": "2020-03-03",
        "status": "A",
        "authorized_official_last_name": "MICLAT",
        "authorized_official_first_name": "TOBY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "714-408-8996"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility in Claremont, CA
• Providers in Claremont, CA by specialty
• Assisted Living Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2020; 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.