MEDICARE: WICKED MEDICAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1144556390
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WICKED MEDICAL

Provider Business Mailing Address
First Line	:	5580 IMPERIAL HWY
Second Line	:
City	:	SOUTH GATE
State	:	CA
Zip	:	90280-7418
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5580 IMPERIAL HWY
Second Line	:
City	:	SOUTH GATE
State	:	CA
Zip	:	90280-7418
Country	:	US
Telephone Number	:	855-850-5888
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOEY TUSIA
Credential	:
Telephone Number	:	562-843-2573

Provider Enumeration Date	:	10/22/2009
Last Update Date	:	07/23/2015

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Directions to “WICKED MEDICAL ” Practice Location

Language	Start Address	Practice Location

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