Provider Demographics
NPI:1881034924
Name:WALKER, DAVON
Entity Type:Individual
Prefix:
First Name:DAVON
Middle Name:
Last Name:WALKER
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 1:1940 W ACACIA AVE
Mailing Address - Street 2:APT. 28
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92545-3787
Mailing Address - Country:US
Mailing Address - Phone:909-463-5392
Mailing Address - Fax:
Practice Address - Street 1:1940 W ACACIA AVE
Practice Address - Street 2:APT. 28
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92545-3787
Practice Address - Country:US
Practice Address - Phone:909-463-5392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-03
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35174167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician