Healthcare Provider Details

I. General information

NPI: 1942323746
Provider Name (Legal Business Name): MR. CARLTON M WALKER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7040 CROMWELL WAY
SACRAMENTO CA
95822-4230
US

IV. Provider business mailing address

7040 CROMWELL WAY
SACRAMENTO CA
95822-4230
US

V. Phone/Fax

Practice location:
  • Phone: 916-519-5308
  • Fax: 916-392-2020
Mailing address:
  • Phone: 916-519-5308
  • Fax: 916-392-2020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: