Healthcare Provider Details

I. General information

NPI: 1578845111
Provider Name (Legal Business Name): IMANI J WALKER DO PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2011
Last Update Date: 09/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11712 MOORPARK ST SUITE 104
STUDIO CITY CA
91604-2154
US

IV. Provider business mailing address

11712 MOORPARK ST SUITE 104
STUDIO CITY CA
91604-2154
US

V. Phone/Fax

Practice location:
  • Phone: 818-761-4670
  • Fax: 818-332-1260
Mailing address:
  • Phone: 818-761-4670
  • Fax: 818-332-1260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number20A9660
License Number StateCA

VIII. Authorized Official

Name: DR. IMANI WALKER
Title or Position: OWNER
Credential: DO
Phone: 818-761-4670