Healthcare Provider Details

I. General information

NPI: 1487366753
Provider Name (Legal Business Name): NAMASHA BAKER-WALLS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2022
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 W REDONDO BEACH BLVD
GARDENA CA
90247-3511
US

IV. Provider business mailing address

10790 RANCHO BERNARDO RD
SAN DIEGO CA
92127-5705
US

V. Phone/Fax

Practice location:
  • Phone: 310-532-4200
  • Fax:
Mailing address:
  • Phone: 858-882-8350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95023523
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95023523
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: