Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | A166677 | CA |
NPI | 1083025183 |
---|---|
Provider Name | Dr. Corey Tyler Walker |
First Address | Torrance, CA 90504-5513 |
Second Address | Los Angeles, CA 90048-3311 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2014 |
Last Update Date | 04/08/2021 |