Healthcare Provider Details

I. General information

NPI: 1386691715
Provider Name (Legal Business Name): BETTY DERRELLENE WALTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 04/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 JANES RD
ARCATA CA
95521-4742
US

IV. Provider business mailing address

323 E MATILIJA ST #110
OJAI CA
93023-2740
US

V. Phone/Fax

Practice location:
  • Phone: 925-225-5837
  • Fax: 925-225-5838
Mailing address:
  • Phone: 805-208-5420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberG23506
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG23506
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: