Provider Demographics
NPI:1770829301
Name:WALKER, JACQUELYN MARTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELYN
Middle Name:MARTIN
Last Name:WALKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:831 S EL MOLINO AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-4411
Mailing Address - Country:US
Mailing Address - Phone:626-795-8495
Mailing Address - Fax:626-449-6440
Practice Address - Street 1:831 S EL MOLINO AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-4411
Practice Address - Country:US
Practice Address - Phone:626-795-8495
Practice Address - Fax:626-449-6440
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-01
Last Update Date:2013-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC40096207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC40096OtherMEDICAL BOARD OF CA