Provider Demographics
NPI:1194976456
Name:EXNOWSKI, JOE JOHN
Entity type:Individual
Prefix:
First Name:JOE
Middle Name:JOHN
Last Name:EXNOWSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 S PACIFIC COAST HWY UNIT 41
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-6159
Mailing Address - Country:US
Mailing Address - Phone:310-387-4778
Mailing Address - Fax:
Practice Address - Street 1:1078 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3403
Practice Address - Country:US
Practice Address - Phone:562-285-0149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-06
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No171M00000XOther Service ProvidersCase Manager/Care Coordinator