NPIMap

Organization Active NPI

Walt Jay Medical Corporation

Doing business as Integrative Industrial and Family Practice Medical Clinics

  • Rehabilitation Chiropractor
  • Montebello, CA
National Provider Identifier
1083769707
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation ChiropractorTaxonomy code 111NR0400X
License
DC16212 Issued in CA
Legal business name
WALT JAY MEDICAL CORPORATION
Doing business as
Integrative Industrial and Family Practice Medical Clinics
Practice address
1701 W Whittier Blvd
Montebello, CA 90640-4004
Phone
(323) 887-3577
Fax
(323) 887-9567
NPI assigned
Jan 24, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Sherine Ganegoda
Title
Office Manager's Assistant
Phone
(213) 483-9902

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111NR0400X DC16212 CA Primary

Addresses

Primary practice location

1701 W Whittier Blvd
Montebello, CA 90640-4004

Mailing address

PO Box 39152
Downey, CA 90239-0152
Phone (310) 724-0597

Other names 1

  • Integrative Industrial and Family Practice Medical Clinics Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Integrative Industrial and Family Practice Medical Clinics6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1701 W Whittier Blvd
Montebello, CA 90640
Phone 2134839902512

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1083769707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 39152",
            "city": "DOWNEY",
            "state": "CA",
            "postal_code": "902390152",
            "telephone_number": "310-724-0597"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 W WHITTIER BLVD",
            "city": "MONTEBELLO",
            "state": "CA",
            "postal_code": "906404004",
            "telephone_number": "323-887-3577",
            "fax_number": "323-887-9567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALT JAY MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GANEGODA",
        "authorized_official_first_name": "SHERINE",
        "authorized_official_title_or_position": "OFFICE MANAGER'S ASSISTANT",
        "authorized_official_telephone_number": "213-483-9902",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "111NR0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor, Rehabilitation",
            "state": "CA",
            "license": "DC16212",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Integrative Industrial and Family Practice Medical Clinics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Montebello, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.