Provider Demographics
NPI:1083316145
Name:WALKER, MAILLA T
Entity Type:Individual
Prefix:MISS
First Name:MAILLA
Middle Name:T
Last Name:WALKER
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:MAILLA
Other - Middle Name:T
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2514 FAIRFIELD ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-2416
Mailing Address - Country:US
Mailing Address - Phone:916-982-9657
Mailing Address - Fax:
Practice Address - Street 1:101 CIRBY HILLS DR
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-4360
Practice Address - Country:US
Practice Address - Phone:916-919-3660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-21
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker