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General NPI Number Information
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NPI Number | 1548441389
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Entity Type | Organization
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Legal Business Name | WALTER JOLLEY DPM A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 11/20/2007
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Last Update Date | 11/20/2007
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Provider Practice Location Address
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Address Line | 5222 BALBOA AVE SUITE 52
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City | SAN DIEGO
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State | CA
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Zip | 92117-6904
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Country | US
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Telephone | 858-560-0390
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Fax | 858-560-0333
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Provider Business Mailing Address
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Address Line | 5222 BALBOA AVE SUITE 52
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City | SAN DIEGO
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State | CA
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Zip | 92117-6904
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Country | US
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Telephone | 858-560-0390
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Fax | 858-560-0333
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Authorized Official
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Title or Position | PROVIDER/OWNER
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Name | DR. WALTER HAROLD JOLLEY
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Credential | DPM
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Telephone | 858-560-0390
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | E1540
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License Number State | CA
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