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Individual

WAYLON ANTHONY JAIME

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
5849 CROCKER ST, LOS ANGELES, CA 90003-1311
(323) 432-4399
Mailing address
5849 CROCKER ST, LOS ANGELES, CA 90003-1311
(323) 432-4399

Taxonomy

Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
E3080207
CA

Other

Enumeration date
12/02/2021
Last updated
12/02/2021
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