Provider Demographics
NPI:1679718340
Name:XPERIENCE MEDICAL INNOVATION
Entity Type:Organization
Organization Name:XPERIENCE MEDICAL INNOVATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:TUSIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-625-1624
Mailing Address - Street 1:115 W 4TH ST PH 7
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-2374
Mailing Address - Country:US
Mailing Address - Phone:818-625-1624
Mailing Address - Fax:
Practice Address - Street 1:115 W 4TH ST PH 7
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-2374
Practice Address - Country:US
Practice Address - Phone:818-625-1624
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-10
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies