Healthcare Provider Details

I. General information

NPI: 1649443334
Provider Name (Legal Business Name): WALTER E YURY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2008
Last Update Date: 04/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 W LA PALMA AVE SUITE 409
ANAHEIM CA
92801-2815
US

IV. Provider business mailing address

1211 W LA PALMA AVE SUITE 409
ANAHEIM CA
92801-2815
US

V. Phone/Fax

Practice location:
  • Phone: 714-879-6009
  • Fax: 714-879-6008
Mailing address:
  • Phone: 714-879-6009
  • Fax: 714-879-6008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number207Q00000X
License Number StateCA

VIII. Authorized Official

Name: WALTER E. YURY
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 714-879-6009