Individual
DR. JESSE WASLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
17822 BEACH BLVD,, SUITE 243, HUNTINGTON BEACH, CA 92647
(714) 843-9060
(714) 843-0699
Mailing address
17822 BEACH BLVD,, SUITE 243, HUNTINGTON BEACH, CA 92647
(714) 843-9060
(714) 843-0699
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
A42184
CA
207RI0011X
Interventional Cardiology Physician
Primary
A42184
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A421840
—
CA
01
—
33-0204047
EMPLOYER ID
CA
01
—
P0014478
RAILROAD MEDICARE
CA
Enumeration date
06/08/2005
Last updated
02/08/2010
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