Starship Medical Corporation

Primary specialty

Non-Pharmacy Dispensing SiteTaxonomy code 332900000X

Legal business name

STARSHIP MEDICAL CORPORATION

Practice address

1703 N Avalon Blvd
Wilmington, CA 90744-1432

Phone

(310) 233-9355

NPI assigned

Feb 23, 2021

Organization subpart

No

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

Authorized official

Name

Eddie Santiago

Title

Administrator

Phone

(818) 610-9360

Specialties & licenses 1

Addresses

Tax ID family

Starship Medical Corporation2 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.

• Starship Medical Corporation

  • Sports Medicine (Preventive Medicine) Physician
  • Wilmington, CA
  • NPI 1902490600
  NPD tax ID

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

{
    "created_epoch": "1614038400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621382400000",
    "number": "1336733039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1703 N AVALON BLVD",
            "city": "WILMINGTON",
            "state": "CA",
            "postal_code": "907441432",
            "telephone_number": "818-518-5980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1703 N AVALON BLVD",
            "city": "WILMINGTON",
            "state": "CA",
            "postal_code": "907441432",
            "telephone_number": "310-233-9355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STARSHIP MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-23",
        "last_updated": "2021-05-19",
        "certification_date": "2021-05-13",
        "status": "A",
        "authorized_official_last_name": "SANTIAGO",
        "authorized_official_first_name": "EDDIE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "818-610-9360"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Carole King Stevenson, RN, MSN, FNP-BC
• Cheryl Stoffel, RN
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• Non-Pharmacy Dispensing Site in Wilmington, CA
• Providers in Wilmington, CA by specialty
• Non-Pharmacy Dispensing Site in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2021; 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.