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General NPI Number Information
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NPI Number | 1578845111
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Entity Type | Organization
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Legal Business Name | IMANI J WALKER DO PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 09/09/2011
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Last Update Date | 09/09/2011
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Provider Practice Location Address
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Address Line | 11712 MOORPARK ST SUITE 104
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City | STUDIO CITY
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State | CA
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Zip | 91604-2154
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Country | US
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Telephone | 818-761-4670
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Fax | 818-332-1260
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Provider Business Mailing Address
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Address Line | 11712 MOORPARK ST SUITE 104
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City | STUDIO CITY
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State | CA
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Zip | 91604-2154
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Country | US
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Telephone | 818-761-4670
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Fax | 818-332-1260
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Authorized Official
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Title or Position | OWNER
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Name | DR. IMANI WALKER
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Credential | DO
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Telephone | 818-761-4670
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 20A9660
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License Number State | CA
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