Healthcare Provider Details

I. General information

NPI: 1114192390
Provider Name (Legal Business Name): WALSH MEDICAL GROUP,A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2008
Last Update Date: 07/20/2022
Certification Date: 07/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

947 S ANAHEIM BLVD STE 115
ANAHEIM CA
92805-5582
US

IV. Provider business mailing address

947 S ANAHEIM BLVD STE 115
ANAHEIM CA
92805-5582
US

V. Phone/Fax

Practice location:
  • Phone: 714-533-7320
  • Fax: 714-533-7321
Mailing address:
  • Phone: 714-533-7320
  • Fax: 714-533-7321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number00A325660
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: LINDSAY MARTINEZ
Title or Position: OFFICE MANAGER
Credential:
Phone: 714-502-1144