MEDICARE: PATSY DELANE WALTER I

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	3747A0650X	Attendant Care Provider

General Provider Information

NPI Number	:	1841831989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATSY DELANE WALTER I

Provider Business Mailing Address
First Line	:	11740 BANDERA AVE APT 512
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90059-2570
Country	:	US
Telephone Number	:	562-474-7132
Fax Number	:

Provider Business Practice Location Address
First Line	:	13902 THUNDERBIRD DR APT 8B
Second Line	:
City	:	SEAL BEACH
State	:	CA
Zip	:	90740-5348
Country	:	US
Telephone Number	:	562-500-6246
Fax Number	:

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

Provider Enumeration Date	:	09/30/2019
Last Update Date	:	09/30/2019

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Directions to “ PATSY DELANE WALTER I ” Practice Location

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