Healthcare Provider Details

I. General information

NPI: 1003048406
Provider Name (Legal Business Name): JAY CALVERT MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2009
Last Update Date: 08/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 N ROXBURY DR SUITE 1001
BEVERLY HILLS CA
90210-4206
US

IV. Provider business mailing address

PO BOX 940358
SIMI VALLEY CA
93094-0358
US

V. Phone/Fax

Practice location:
  • Phone: 805-581-5575
  • Fax:
Mailing address:
  • Phone: 805-581-5575
  • Fax: 949-258-5984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MELISSA FAVALE
Title or Position: ADMINISTRATOR
Credential:
Phone: 805-581-5575