Provider Demographics
NPI:1093913121
Name:WALKER, LENA M (STUDENT)
Entity Type:Individual
Prefix:MS
First Name:LENA
Middle Name:M
Last Name:WALKER
Suffix:
Gender:F
Credentials:STUDENT
Other - Prefix:MS
Other - First Name:LENA
Other - Middle Name:M
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:831 E ARROW HWY
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-2535
Mailing Address - Country:US
Mailing Address - Phone:909-398-4383
Mailing Address - Fax:909-398-0127
Practice Address - Street 1:831 E ARROW HWY
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-2535
Practice Address - Country:US
Practice Address - Phone:909-398-4383
Practice Address - Fax:909-398-0127
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1901011744R1102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744R1102XOther Service ProvidersSpecialistResearch Study
Provider Identifiers
StateIdentifier IDID TypeIssuer
3249OtherCAS NUMBER
CA190101OtherPROVIDERS NUMBER