Healthcare Provider Details

I. General information

NPI: 1861655433
Provider Name (Legal Business Name): S D WALKER MEDICAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8535 SANTA MONICA BLVD
WEST HOLLYWOOD CA
90069-4100
US

IV. Provider business mailing address

8581 SANTA MONICA BLVD #229
WEST HOLLYWOOD CA
90069-4120
US

V. Phone/Fax

Practice location:
  • Phone: 310-659-1959
  • Fax: 310-659-4769
Mailing address:
  • Phone: 310-659-1959
  • Fax: 310-659-4769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License NumberA62652
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA62652
License Number StateCA

VIII. Authorized Official

Name: DR. BRUCE J. WALKER
Title or Position: OWNER/PRESIDENT
Credential: M.D.
Phone: 310-659-1959