Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | Y3865626 | CA |
Y | 213ES0000X | Sports Medicine | Y3865626 | CA |
NPI | 1114555133 |
---|---|
Provider Name | Lilly Paige Walker |
First Address | Concord, CA 94519-1922 |
Second Address | Pullman, WA 99163-9916 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2020 |
Last Update Date | 27/03/2020 |