Stateside Medical LLC
NPI #1952936312 in Upland, California
Provider Information
- NPI Number
- 1952936312
- Entity Type
- Organization
- Organization Name
- Stateside Medical LLC
- Primary Specialty
- Assisted Living Facility
- Enumeration Date
- Mar 5, 2020
- Last Updated
- Mar 5, 2020
Practice Location
- Address
- 359 W LANGSTON ST
- City
- Upland
- State
- California
- ZIP Code
- 91786-3128
- Phone
- (714) 408-8996
Authorized Official
- Name
- TOBY MICLAT
- Title
- ADMINISTRATOR
- Phone
- (714) 408-8996
Specialties & Taxonomy Codes
| Specialty |
|---|
| Assisted Living Facility |
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