Healthcare Provider Details

I. General information

NPI: 1881271849
Provider Name (Legal Business Name): JESSICA WALSH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 E AVENUE I STE 21
LANCASTER CA
93535-1916
US

IV. Provider business mailing address

335 E AVENUE I STE 21
LANCASTER CA
93535-1916
US

V. Phone/Fax

Practice location:
  • Phone: 661-471-4000
  • Fax:
Mailing address:
  • Phone: 661-471-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA195182
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: