Healthcare Provider Details

I. General information

NPI: 1538310065
Provider Name (Legal Business Name): STONEBUSTERS , LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2008
Last Update Date: 10/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 S FIGUEROA ST # 6001
LOS ANGELES CA
90007-2049
US

IV. Provider business mailing address

6339 E SPEEDWAY BLVD SUITE 201
TUCSON AZ
85710-1147
US

V. Phone/Fax

Practice location:
  • Phone: 213-749-1249
  • Fax:
Mailing address:
  • Phone: 520-547-4130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QL0400X
TaxonomyLithotripsy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRIS GLEASON
Title or Position: CEO
Credential:
Phone: 520-547-4130