Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | A80933 | CA |
NPI | 1235271693 |
---|---|
Provider Name | Kimberly R Walton |
First Address | Tamuning, GU 96913-3602 |
Second Address | Tamuning, GU 96913-3602 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2007 |
Last Update Date | 17/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A809330 | (05) | CA |
H04638 | (02) | CA |