Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1033431101 |
---|---|
Provider Name | Randy Walker |
First Address | Northridge, CA 91325-2003 |
Second Address | Northridge, CA 91325-2003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2010 |
Last Update Date | 17/02/2010 |