1497314991 NPI number — MARTHA WALCH, PHD.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497314991 NPI number — MARTHA WALCH, PHD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARTHA WALCH, PHD.
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:
1497314991
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/08/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2313 LOCKHILL SELMA RD STE 208
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78230-3007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-446-7049
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6800 PARK TEN BLVD.
Provider Second Line Business Practice Location Address:
SUITE 212 NORTH
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-409-7049
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/08/2019

Additional Information

Authorized Official

Authorized Official Last Name:
WALCH
Authorized Official First Name:
MARTHA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
210-446-7049

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1285615005 . This is a "NPI" identifier . This identifiers is of the category "OTHER".




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