Individual
MR. JAY BECKETT FEDERHART
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
200 W ARBOR DR, SAN DIEGO, CA 92103-9000
(800) 926-8273
(888) 539-8781
Mailing address
FILE 57326, LOS ANGELES, CA 90074-7326
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
G84686
CA
2085R0204X
Vascular & Interventional Radiology Physician
G84686
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G846860
—
CA
05
—
1568422558
—
CA
01
—
G84686
BC/BS OF CA
CA
Enumeration date
03/24/2006
Last updated
12/21/2023
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