Provider Demographics
NPI:1326417650
Name:STATMOBILE, INC.
Entity Type:Organization
Organization Name:STATMOBILE, INC.
Other - Org Name:ALERRA HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:CANALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-258-9883
Mailing Address - Street 1:34443 VIA VERDE B
Mailing Address - Street 2:
Mailing Address - City:CAPISTRANO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92624
Mailing Address - Country:US
Mailing Address - Phone:949-258-9883
Mailing Address - Fax:949-281-7707
Practice Address - Street 1:34443 VIA VERDE B
Practice Address - Street 2:
Practice Address - City:CAPISTRANO BEACH
Practice Address - State:CA
Practice Address - Zip Code:92624
Practice Address - Country:US
Practice Address - Phone:949-258-9883
Practice Address - Fax:949-281-7707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-16
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR0208X, 335V00000X
CA291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
No335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D2108928OtherCLIA
CAFAC00072258OtherPORTABLE XRAY REGISTRATION DHS