Provider Demographics
NPI:1265130595
Name:WALTERS, DEVIN MICHAEL
Entity type:Individual
Prefix:
First Name:DEVIN
Middle Name:MICHAEL
Last Name:WALTERS
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 1:707 E TAHQUITZ CANYON WAY STE 14
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-6773
Mailing Address - Country:US
Mailing Address - Phone:760-851-5690
Mailing Address - Fax:
Practice Address - Street 1:707 E TAHQUITZ CANYON WAY STE 14
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-6773
Practice Address - Country:US
Practice Address - Phone:760-851-5690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other