Provider Demographics
NPI:1578845111
Name:IMANI J WALKER DO PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:IMANI J WALKER DO PROFESSIONAL CORPORATION
Other - Org Name:IMANI WALKER DO PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IMANI
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:818-761-4670
Mailing Address - Street 1:11712 MOORPARK ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-2154
Mailing Address - Country:US
Mailing Address - Phone:818-761-4670
Mailing Address - Fax:818-332-1260
Practice Address - Street 1:11712 MOORPARK ST
Practice Address - Street 2:SUITE 104
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-2154
Practice Address - Country:US
Practice Address - Phone:818-761-4670
Practice Address - Fax:818-332-1260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A96602084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty