Provider Demographics
NPI:1801196571
Name:BLUE WATER ENTERPRISES, INC.
Entity Type:Organization
Organization Name:BLUE WATER ENTERPRISES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:NESPOLI
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:310-329-9442
Mailing Address - Street 1:18039 CRENSHAW BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-5126
Mailing Address - Country:US
Mailing Address - Phone:310-329-9442
Mailing Address - Fax:
Practice Address - Street 1:18039 CRENSHAW BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90504-5126
Practice Address - Country:US
Practice Address - Phone:310-329-9442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-28
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy