Healthcare Provider Details

I. General information

NPI: 1891024477
Provider Name (Legal Business Name): XTREME MEDICAL SUPPLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2009
Last Update Date: 07/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5580 IMPERIAL HWY
SOUTH GATE CA
90280-7418
US

IV. Provider business mailing address

5580 IMPERIAL HWY
SOUTH GATE CA
90280-7418
US

V. Phone/Fax

Practice location:
  • Phone: 562-231-3850
  • Fax:
Mailing address:
  • Phone: 562-231-3850
  • 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: MR. JOEY TUSIA
Title or Position: PRESIDENT
Credential:
Phone: 562-231-3850