Healthcare Provider Details

I. General information

NPI: 1407593379
Provider Name (Legal Business Name): SAMANTHA AYANNA WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2022
Last Update Date: 11/27/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 S ANAHEIM BLVD
ANAHEIM CA
92805-6205
US

IV. Provider business mailing address

510 S 2ND AVE
COVINA CA
91723-3017
US

V. Phone/Fax

Practice location:
  • Phone: 714-948-7641
  • Fax: 714-689-1381
Mailing address:
  • Phone: 626-974-8123
  • Fax: 626-974-8198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number116168
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: