1124265954 NPI number — BIOSTEM,INC

Table of content: (NPI 1124265954)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124265954 NPI number — BIOSTEM,INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BIOSTEM,INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124265954
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/15/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14111 FREEWAY DR STE 312
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA FE SPRINGS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90670-5822
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-894-7195
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4000 LONG BEACH BVLD
Provider Second Line Business Practice Location Address:
SUITE 226
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-894-7195
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/15/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BAMIDELE
Authorized Official First Name:
STEPHENSON
Authorized Official Middle Name:
O
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
866-894-7195

Provider Taxonomy Codes

  • Taxonomy code: 207U00000X , with the licence number:  RAML 2236-36 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207UN0901X , with the licence number: RAML 1258-19 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2471N0900X , with the licence number: RHN 2003 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)