Healthcare Provider Details

I. General information

NPI: 1073260436
Provider Name (Legal Business Name): JULIANA KATHRYN WALTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2022
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 HOSPITAL DR
SACRAMENTO CA
95823-5403
US

IV. Provider business mailing address

7500 HOSPITAL DR
SACRAMENTO CA
95823-5403
US

V. Phone/Fax

Practice location:
  • Phone: 916-423-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number64714
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: