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General NPI Number Information
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NPI Number | 1922329606
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Entity Type | Organization
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Legal Business Name | JAY C. MORTIMER, MD, A MEDICAL CORP.
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Dates
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Enumeration Date | 06/17/2010
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Last Update Date | 06/17/2010
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Provider Practice Location Address
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Address Line | 4419 VAN NUYS BLVD SUITE 405
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-2910
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Country | US
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Telephone | 818-995-8766
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Fax |
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Provider Business Mailing Address
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Address Line | 4419 VAN NUYS BLVD SUITE 405
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-2910
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Country | US
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Telephone | 818-995-8766
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAY C. MORTIMER
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Credential | MD
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Telephone | 818-995-8766
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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