Provider Demographics
NPI:1225695604
Name:AHHAITTY, WALTER
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:
Last Name:AHHAITTY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10175 SLATER AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4717
Mailing Address - Country:US
Mailing Address - Phone:714-962-6673
Mailing Address - Fax:714-962-6343
Practice Address - Street 1:400 CONTINENTAL BLVD FL 6
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-5074
Practice Address - Country:US
Practice Address - Phone:213-387-5772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-21
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker