Healthcare Provider Details

I. General information

NPI: 1295269264
Provider Name (Legal Business Name): NICOLAS ASHER WALTON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2017
Last Update Date: 08/31/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E CHURCH ST HOSPITALIST OFFICE
SANTA MARIA CA
93454-5906
US

IV. Provider business mailing address

1400 E CHURCH ST C/O HOSPITALIST OFFICE
SANTA MARIA CA
93454-5906
US

V. Phone/Fax

Practice location:
  • Phone: 805-739-3000
  • Fax:
Mailing address:
  • Phone: 805-739-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A16928
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number20A16928
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: