Wave Medical Corporation

Primary specialty

Physiological LaboratoryTaxonomy code 293D00000X

Legal business name

WAVE MEDICAL CORPORATION

Practice address

2070 Century Park E FL 5
Los Angeles, CA 90067-1907

Phone

(310) 200-0945

NPI assigned

Aug 10, 2006

Organization subpart

No

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

Authorized official

Name

Timothy T Davis, M.D.

Title

Ceo

Phone

(310) 200-0945

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192320000000",
    "number": "1275544918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 SHELDON ST",
            "city": "EL SEGUNDO",
            "state": "CA",
            "postal_code": "902453915",
            "telephone_number": "310-200-0945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2070 CENTURY PARK E FL 5",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900671907",
            "telephone_number": "310-200-0945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAVE MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-10",
        "last_updated": "2007-10-14",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "310-200-0945",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "293D00000X",
            "taxonomy_group": "",
            "desc": "Physiological Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole Danielle Watts, LCSW
• Sydney Watts
• Booker TK Waugh
• Sophia Waugh
• Wave Integrative Psychiatry, PC
• Wave Plastic Surgery Center
• Wave Psychiatric Group, PC
• Wavemind Inc, a Psychology Corporation
• Jonathan Fredric Waxer, MD
• Robert D Waxler, M.D.

• Physiological Laboratory in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Physiological Laboratory in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2007; 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.