Healthcare Provider Details

I. General information

NPI: 1538384243
Provider Name (Legal Business Name): LORETTA WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 N 9TH ST
GROVER BEACH CA
93433-2122
US

IV. Provider business mailing address

PO BOX 336
GROVER BEACH CA
93483-0336
US

V. Phone/Fax

Practice location:
  • Phone: 805-481-1523
  • Fax: 805-481-1269
Mailing address:
  • Phone: 805-481-1523
  • Fax: 805-481-1269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHAD1922
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: