Provider Demographics
NPI:1982135240
Name:WAJTA, LLC
Entity Type:Organization
Organization Name:WAJTA, LLC
Other - Org Name:LICE CLINICS OF AMERICA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-500-5537
Mailing Address - Street 1:7680 MONTEREY ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-5271
Mailing Address - Country:US
Mailing Address - Phone:408-500-5537
Mailing Address - Fax:
Practice Address - Street 1:7680 MONTEREY ST
Practice Address - Street 2:SUITE 104
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-5271
Practice Address - Country:US
Practice Address - Phone:408-500-5537
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Single Specialty