Walt Jay Medical Corporation

NPI #1154509297 in Los Angeles, California

Provider Information

NPI Number: 1154509297
Entity Type: Organization
Organization Name: Walt Jay Medical Corporation
Primary Specialty: General Practice
Enumeration Date: Jan 31, 2008
Last Updated: Jan 31, 2008

Practice Location

Address: 1930 WILSHIRE BLVD
Address 2: SUITE 600
City: Los Angeles
State: California
ZIP Code: 90057-3605
Phone: (213) 483-9902

Authorized Official

Name: MRS. SHERINE GANEGODA III
Title: ASSISTANT TO OFFICE MANAGER
Phone: (213) 483-9902

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
General Practice	208D00000X	Primary

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