# WALT JAY MEDICAL CORPORATION

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

## Provider details

- **NPI number:** 1831238492
- **Authorized official:** SHERINE GANEGODA (OFFICE MANAGER'S ASSISTANT)
- **Authorized official phone:** (213) 483-9902

## Contact information

- **Practice address:** 1930 WILSHIRE BLVD, SUITE 505, LOS ANGELES, CA 90057-3605
- **Practice address phone:** (213) 483-9902
- **Mailing address:** 2011 PRAY ST, FULLERTON, CA 92833-5070
- **Mailing address phone:** (661) 803-0468

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | G00078400 | CA | Yes |

## Other

- **Enumeration date:** 02/06/2007
- **Last updated:** 08/22/2020