Provider Demographics
NPI:1205012952
Name:SOUTH BAY EXPRESS NURSING , INC.
Entity Type:Organization
Organization Name:SOUTH BAY EXPRESS NURSING , INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MADRIGAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-518-3300
Mailing Address - Street 1:809 N AVALON BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:CA
Mailing Address - Zip Code:90744-4501
Mailing Address - Country:US
Mailing Address - Phone:310-518-3300
Mailing Address - Fax:310-518-3404
Practice Address - Street 1:809 N AVALON BLVD STE B
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:CA
Practice Address - Zip Code:90744-4501
Practice Address - Country:US
Practice Address - Phone:310-518-3300
Practice Address - Fax:310-518-3404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health