Organization
ED S JESALVA MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ED SANTOS JESALVA MD (OWNER)
(805) 374-1120
Entity
Organization
Contact information
Practice address
2659 TOWNSGATE RD, SUITE 209, WESTLAKE VILLAGE, CA 91361-2710
(805) 374-1120
(805) 374-1124
Mailing address
2659 TOWNSGATE RD, SUITE 209, WESTLAKE VILLAGE, CA 91361-2710
(805) 374-1120
(805) 374-1124
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
G058063
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1275791980
NPI
CA
01
—
W15811
PTAN
CA
Enumeration date
05/08/2012
Last updated
05/31/2022
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