Organization
STATESIDE MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TOBY MICLAT (ADMINISTRATOR)
(714) 408-8996
Entity
Organization
Contact information
Practice address
380 W BASELINE RD, CLAREMONT, CA 91711-1751
(714) 408-8996
Mailing address
1920 N INDIAN HILL BLVD, CLAREMONT, CA 91711-2721
(714) 408-8996
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
03/03/2020
Last updated
03/03/2020
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