Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1043570211 |
---|---|
Provider Name | Walter Bunkley |
First Address | Compton, CA 90222-7109 |
Second Address | Compton, CA 90222-7109 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2012 |
Last Update Date | 22/05/2012 |