Healthcare Provider Details

I. General information

NPI: 1871280669
Provider Name (Legal Business Name): SAMIR WALKMAN PMHNP-BC, MSN, RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2023
Last Update Date: 02/16/2025
Certification Date: 02/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42923 N FORK DR
THREE RIVERS CA
93271-9644
US

IV. Provider business mailing address

22 ANTIQUE ROSE
IRVINE CA
92620-4802
US

V. Phone/Fax

Practice location:
  • Phone: 949-561-8720
  • Fax:
Mailing address:
  • Phone: 949-561-8720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95302275
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95033911
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: