Provider Demographics
NPI:1609341197
Name:WALDEN, AYESHA FAZLI (WHNP/CNM)
Entity Type:Individual
Prefix:
First Name:AYESHA
Middle Name:FAZLI
Last Name:WALDEN
Suffix:
Gender:F
Credentials:WHNP/CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:352 AQUA WAY
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-2161
Mailing Address - Country:US
Mailing Address - Phone:805-300-5153
Mailing Address - Fax:
Practice Address - Street 1:229 W CHERRY AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3401
Practice Address - Country:US
Practice Address - Phone:559-789-0277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95010234363LW0102X
CA235981367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health