Healthcare Provider Details

I. General information

NPI: 1366453078
Provider Name (Legal Business Name): LORETTA L WALKER ENTERPRISES INCORPERATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 08/22/2020
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 336 160 N. 9TH ST
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 Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberHAD2723
License Number StateCA

VIII. Authorized Official

Name: MRS. LORETTA WALKER
Title or Position: PRESIDENT
Credential:
Phone: 805-481-1523