Healthcare Provider Details

I. General information

NPI: 1548639172
Provider Name (Legal Business Name): ANNE WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2015
Last Update Date: 09/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 CYPRESS WAY
ROLLING HILLS ESTATES CA
90274-3416
US

IV. Provider business mailing address

39 CYPRESS WAY
ROLLING HILLS ESTATES CA
90274-3416
US

V. Phone/Fax

Practice location:
  • Phone: 310-407-9243
  • Fax:
Mailing address:
  • Phone: 310-407-9243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberG72209
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: