Healthcare Provider Details

I. General information

NPI: 1831201193
Provider Name (Legal Business Name): JAY CALVERT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 N ROXBURY DR STE 1001
BEVERLY HILLS CA
90210-4213
US

IV. Provider business mailing address

PO BOX 940249
SIMI VALLEY CA
93094-0249
US

V. Phone/Fax

Practice location:
  • Phone: 310-777-8800
  • Fax: 310-248-6258
Mailing address:
  • Phone: 805-581-5575
  • Fax: 805-581-4808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberA75573
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: