Healthcare Provider Details

I. General information

NPI: 1972096600
Provider Name (Legal Business Name): TRICIA KIM ANN WALTERS LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2018
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

822 E 87TH PL
LOS ANGELES CA
90002-1010
US

IV. Provider business mailing address

822 E 87TH PL
LOS ANGELES CA
90002-1010
US

V. Phone/Fax

Practice location:
  • Phone: 310-930-7075
  • Fax:
Mailing address:
  • Phone: 310-930-7075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN275392
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: