1629118906 NPI number — RICHARD L. WALTER, M.D., A MEDICAL CORPORATION

Table of content: (NPI 1629118906)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629118906 NPI number — RICHARD L. WALTER, M.D., A MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICHARD L. WALTER, M.D., A MEDICAL 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:
1629118906
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18375 VENTURA BLVD
Provider Second Line Business Mailing Address:
SUITE 614
Provider Business Mailing Address City Name:
TARZANA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91356-4218
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-908-8048
Provider Business Mailing Address Fax Number:
818-908-8072

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5525 ETIWANDA AVE
Provider Second Line Business Practice Location Address:
SUITE 318
Provider Business Practice Location Address City Name:
TARZANA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91356-3647
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-528-1270
Provider Business Practice Location Address Fax Number:
818-528-1275
Provider Enumeration Date:
02/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MARTINEZ
Authorized Official First Name:
PAULA
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING
Authorized Official Telephone Number:
818-908-8048

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  G31570 , 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)





Copyright © 2007-2025 www.npivalidator.com