1417075490 NPI number — LORENZO G. WALKER, M.D., A PROFESSIONAL CORPORATION

Table of content: (NPI 1417075490)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417075490 NPI number — LORENZO G. WALKER, M.D., A PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LORENZO G. WALKER, M.D., A PROFESSIONAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417075490
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2001 SOLAR DR
Provider Second Line Business Mailing Address:
SUITE 275
Provider Business Mailing Address City Name:
OXNARD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93036-2645
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-485-7764
Provider Business Mailing Address Fax Number:
805-604-4763

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2001 SOLAR DR
Provider Second Line Business Practice Location Address:
SUITE 275
Provider Business Practice Location Address City Name:
OXNARD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93036-2645
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-485-7764
Provider Business Practice Location Address Fax Number:
805-604-4763
Provider Enumeration Date:
03/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WALKER
Authorized Official First Name:
LORENZO
Authorized Official Middle Name:
G.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
805-485-7764

Provider Taxonomy Codes

  • Taxonomy code: 207XS0106X , with the licence number:  G62014 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DQ9184 . This is a "RAIL ROAD" identifier . This identifiers is of the category "OTHER".




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