MEDICARE: LETRICIA LADIAMOND WALTON LVN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	VN246202	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063973022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LETRICIA LADIAMOND WALTON LVN

Provider Business Mailing Address
First Line	:	26625 ROUNDUP WAY
Second Line	:
City	:	APPLE VALLEY
State	:	CA
Zip	:	92308-0542
Country	:	US
Telephone Number	:	323-360-3779
Fax Number	:

Provider Business Practice Location Address
First Line	:	26625 ROUNDUP WAY
Second Line	:
City	:	APPLE VALLEY
State	:	CA
Zip	:	92308-0542
Country	:	US
Telephone Number	:	323-360-3779
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2019
Last Update Date	:	04/07/2026

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