Healthcare Provider Details

I. General information

NPI: 1225098361
Provider Name (Legal Business Name): AVA WALTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 07/29/2021
Certification Date: 07/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2091 KOLEKOLE AVE BLDG 688
SCHOFIELD BARRACKS HI
96857-5041
US

IV. Provider business mailing address

95-1063 KOOLANI DR UNIT 359
MILILANI HI
96789-6000
US

V. Phone/Fax

Practice location:
  • Phone: 808-433-8069
  • Fax: 808-433-8578
Mailing address:
  • Phone: 910-920-8073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number13063
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: