Provider Demographics
NPI:1003204397
Name:XENCO MEDICAL LLC
Entity Type:Organization
Organization Name:XENCO MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVILA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-202-1522
Mailing Address - Street 1:9930 MESA RIM RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-2910
Mailing Address - Country:US
Mailing Address - Phone:858-202-1522
Mailing Address - Fax:
Practice Address - Street 1:9930 MESA RIM RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-2910
Practice Address - Country:US
Practice Address - Phone:858-202-1522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-08
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies