Healthcare Provider Details

I. General information

NPI: 1770829301
Provider Name (Legal Business Name): JACQUELYN MARTIN WALKER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/01/2013
Last Update Date: 01/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 S EL MOLINO AVE
PASADENA CA
91106-4411
US

IV. Provider business mailing address

831 S EL MOLINO AVE
PASADENA CA
91106-4411
US

V. Phone/Fax

Practice location:
  • Phone: 626-795-8495
  • Fax: 626-449-6440
Mailing address:
  • Phone: 626-795-8495
  • Fax: 626-449-6440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberC40096
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: