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General NPI Number Information
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NPI Number | 1225271786
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Entity Type | Organization
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Legal Business Name | J SHAY ANESTHESIA AND PAIN MANAGEMENT
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Dates
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Enumeration Date | 04/14/2009
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Last Update Date | 04/14/2009
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Provider Practice Location Address
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Address Line | 555 S 7TH AVE
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City | BARSTOW
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State | CA
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Zip | 92311-3043
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Country | US
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Telephone | 760-957-3224
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Fax | 760-957-3053
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Provider Business Mailing Address
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Address Line | 611 KELLY DR
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City | BARSTOW
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State | CA
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Zip | 92311-2919
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Country | US
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Telephone | 760-957-3224
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Fax | 760-957-3053
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. JED SHAY
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Credential | M.D.
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Telephone | 760-957-3224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | C51490
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License Number State | CA
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