Healthcare Provider Details

I. General information

NPI: 1013049667
Provider Name (Legal Business Name): WALTER W. PRYCE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12102 WASHINGTON BLVD STE 200
WHITTIER CA
90606-2674
US

IV. Provider business mailing address

2801 PALM AVE
MANHATTAN BEACH CA
90266-2350
US

V. Phone/Fax

Practice location:
  • Phone: 562-464-4717
  • Fax: 562-464-5004
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG28248
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: