Healthcare Provider Details

I. General information

NPI: 1497883060
Provider Name (Legal Business Name): MICHAEL CLAUDE WALKER PSY.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 03/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5790 MAGNOLIA AVE SUITE 202
RIVERSIDE CA
92506-1874
US

IV. Provider business mailing address

5790 MAGNOLIA AVE SUITE 202
RIVERSIDE CA
92506-1874
US

V. Phone/Fax

Practice location:
  • Phone: 909-229-1253
  • Fax: 951-781-1303
Mailing address:
  • Phone: 909-229-1253
  • Fax: 951-781-1303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY20652
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: