Healthcare Provider Details

I. General information

NPI: 1376688457
Provider Name (Legal Business Name): IRWIN WALOT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W CARSON ST BOX 480
TORRANCE CA
90502-2004
US

IV. Provider business mailing address

1000 W CARSON ST BOX 480
TORRANCE CA
90502-2004
US

V. Phone/Fax

Practice location:
  • Phone: 310-222-2808
  • Fax:
Mailing address:
  • Phone: 310-222-2808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberG57034
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: