Healthcare Provider Details

I. General information

NPI: 1619807773
Provider Name (Legal Business Name): BSBW INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2509 S POWER RD STE 105
MESA AZ
85209-6696
US

IV. Provider business mailing address

2509 S POWER RD STE 105
MESA AZ
85209-6696
US

V. Phone/Fax

Practice location:
  • Phone: 623-624-7420
  • Fax:
Mailing address:
  • Phone: 623-624-7420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JAKE GABBARD
Title or Position: ADMINISTRATOR
Credential:
Phone: 714-904-4104