Healthcare Provider Details

I. General information

NPI: 1801434832
Provider Name (Legal Business Name): QUINTON C WALKER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2019
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 SPAANS DR STE C
GALT CA
95632-8609
US

IV. Provider business mailing address

768 GRIFFEY WAY
GALT CA
95632-3065
US

V. Phone/Fax

Practice location:
  • Phone: 209-744-9909
  • Fax:
Mailing address:
  • Phone: 209-744-9909
  • Fax: 925-849-6832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number7896
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: