Statmobile, Inc.

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

STATMOBILE, INC.

Practice address

34443 Via Verde B
Capistrano Beach, CA 92624

Phone

(949) 258-9883

Fax

(949) 281-7707

NPI assigned

Sep 16, 2015

Organization subpart

No

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

Authorized official

Name

Martin A Canales

Title

Principal

Phone

(949) 258-9883

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Alerra Healthcare Doing business as

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

{
    "created_epoch": "1442361600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588723200000",
    "number": "1326417650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34443 VIA VERDE B",
            "city": "CAPISTRANO BEACH",
            "state": "CA",
            "postal_code": "92624",
            "telephone_number": "949-258-9883",
            "fax_number": "949-281-7707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34443 VIA VERDE B",
            "city": "CAPISTRANO BEACH",
            "state": "CA",
            "postal_code": "92624",
            "telephone_number": "949-258-9883",
            "fax_number": "949-281-7707"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "92 Argonaut",
            "address_2": "Suite 170",
            "address_purpose": "LOCATION",
            "city": "Aliso Viejo",
            "state": "CA",
            "postal_code": "926564116",
            "country_code": "US",
            "telephone_number": "949-544-4905",
            "fax_number": "949-916-9333",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "STATMOBILE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-16",
        "last_updated": "2020-05-06",
        "certification_date": "2020-05-06",
        "status": "A",
        "authorized_official_last_name": "CANALES",
        "authorized_official_first_name": "MARTIN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRINCIPAL",
        "authorized_official_telephone_number": "949-258-9883"
    },
    "taxonomies": [
        {
            "code": "261QR0208X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology, Mobile",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "CA",
            "license": null,
            "primary": true
        },
        {
            "code": "335V00000X",
            "taxonomy_group": "",
            "desc": "Portable X-ray and/or Other Portable Diagnostic Imaging Supplier",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "05D2108928",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PORTABLE XRAY REGISTRATION DHS",
            "identifier": "FAC00072258",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Alerra Healthcare",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Alerra Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Capistrano Beach, CA
• Clinical Medical Laboratory in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 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.