Provider Demographics
NPI:1740911908
Name:NOJ, WALTER ESTUARDO JR
Entity type:Individual
Prefix:MR
First Name:WALTER
Middle Name:ESTUARDO
Last Name:NOJ
Suffix:JR
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 1:2001 N RANCHO AVE
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324
Mailing Address - Country:US
Mailing Address - Phone:909-676-3593
Mailing Address - Fax:
Practice Address - Street 1:21600 OXNARD STREET, SUITE 1030
Practice Address - Street 2:
Practice Address - City:WOODLANDS HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367
Practice Address - Country:US
Practice Address - Phone:877-206-1009
Practice Address - Fax:818-457-4617
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician