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General NPI Number Information
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NPI Number | 1841892593
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Entity Type | Individual
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Provider Name | DORMICO LATASHIA WALKER DNP, MSN-L, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 11/09/2020
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Last Update Date | 09/14/2024
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Provider Practice Location Address
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Address Line | 4633 OLD IRONSIDES DR STE 304
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City | SANTA CLARA
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State | CA
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Zip | 95054-1846
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Country | US
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Telephone | 323-745-8323
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Fax |
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Provider Business Mailing Address
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Address Line | 3101 N CENTRAL AVE STE 550
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City | PHOENIX
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State | AZ
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Zip | 85012-2635
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Country | US
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Telephone | 602-230-7373
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Fax | 602-682-7455
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | RN202021
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | NP95027503
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | CNP-249922
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License Number State | AZ
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Taxonomy #4
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Taxonomy Code | 163WP0807X
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Taxonomy Name | Child & Adolescent Psychiatric/Mental Health Registered Nurse
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License Number | RN95310089
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License Number State | CA
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