# WALT JAY MEDICAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Integrative Industrial & Family Practice Medical Clinics
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154509297
- **Authorized official:** MRS. SHERINE GANEGODA III (ASSISTANT TO OFFICE MANAGER)
- **Authorized official phone:** (213) 483-9902

## Contact information

- **Practice address:** 1930 WILSHIRE BLVD, SUITE 600, LOS ANGELES, CA 90057-3605
- **Practice address phone:** (213) 483-9902
- **Practice address fax:** (213) 483-5174
- **Mailing address:** 1930 WILSHIRE BLVD, SUITE 600, LOS ANGELES, CA 90057-3605
- **Mailing address phone:** (213) 483-9902
- **Mailing address fax:** (213) 483-5174

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/31/2008
- **Last updated:** 01/31/2008