Healthcare Provider Details

I. General information

NPI: 1669763256
Provider Name (Legal Business Name): WALK WITH ME, FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 W PUTNAM AVE STE 4
PORTERVILLE CA
93257-3269
US

IV. Provider business mailing address

560 W PUTNAM AVE STE 4
PORTERVILLE CA
93257-3269
US

V. Phone/Fax

Practice location:
  • Phone: 559-789-9314
  • Fax:
Mailing address:
  • Phone: 559-789-9314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. REBECCA L GERVASI
Title or Position: IMF
Credential:
Phone: 559-789-9314