Provider Demographics
NPI:1780836114
Name:WALKER, MIGNON (MD)
Entity Type:Individual
Prefix:DR
First Name:MIGNON
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2447 PACIFIC COAST HWY FL 2
Mailing Address - Street 2:
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-2743
Mailing Address - Country:US
Mailing Address - Phone:310-941-1513
Mailing Address - Fax:888-611-0861
Practice Address - Street 1:2447 PACIFIC COAST HWY FL 2
Practice Address - Street 2:
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-2743
Practice Address - Country:US
Practice Address - Phone:310-941-1513
Practice Address - Fax:888-611-0861
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-16
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77862208D00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice