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NPI Code Detail

MEDICARE: WAVE MEDICAL CORPORATION

MEDICARE: WAVE MEDICAL CORPORATION
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1293D00000XPhysiological Laboratory

General Provider Information

NPI Number : 1275544918
Entity Type Code : Organization
Provider Name (Legal Business Name) : WAVE MEDICAL CORPORATION
Provider Business Mailing Address
First Line : 122 SHELDON ST
Second Line :
City : EL SEGUNDO
State : CA
Zip : 90245-3915
Country : US
Telephone Number : 310-200-0945
Fax Number :
Provider Business Practice Location Address
First Line : 2070 CENTURY PARK E FL 5
Second Line :
City : LOS ANGELES
State : CA
Zip : 90067-1907
Country : US
Telephone Number : 310-200-0945
Fax Number :
Authorized Official
Title or Position : CEO
Name : TIMOTHY T DAVIS
Credential : M.D.
Telephone Number : 310-200-0945
Provider Enumeration Date : 08/10/2006
Last Update Date : 10/14/2007

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Directions to “WAVE MEDICAL CORPORATION ” Practice Location

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