Provider Demographics
NPI:1225434343
Name:EXPER-TECH
Entity Type:Organization
Organization Name:EXPER-TECH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, SONOGRAPHER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:NIELSON
Authorized Official - Suffix:
Authorized Official - Credentials:RVT
Authorized Official - Phone:805-705-5003
Mailing Address - Street 1:913 LINDENCLIFF ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-2710
Mailing Address - Country:US
Mailing Address - Phone:805-705-5003
Mailing Address - Fax:
Practice Address - Street 1:1437 ARMACOST AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-2207
Practice Address - Country:US
Practice Address - Phone:805-705-5003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-17
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA154435291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory