| Organization Name: | WALT JAY MEDICAL CORPORATION |
| NPI Number: | 1154509297 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SHERINE GANEGODA (ASSISTANT TO OFFICE MANAGER) |
| Mailing Address: | 1930 Wilshire Blvd Suite 600 Los Angeles |
| State: | CA US |
| Postal Code: | 900573605 |
| Phone Number: | 2134839902 |
| Fax Number: | 2134835174 |
| NPI Enumeration Date: | 01/31/2008 |
| NPI Last Update Date: | 01/31/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |