Provider Demographics
NPI:1841831989
Name:WALTER, PATSY DELANE I
Entity type:Individual
Prefix:
First Name:PATSY
Middle Name:DELANE
Last Name:WALTER
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11740 BANDERA AVE APT 512
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90059-2570
Mailing Address - Country:US
Mailing Address - Phone:562-474-7132
Mailing Address - Fax:
Practice Address - Street 1:13902 THUNDERBIRD DR APT 8B
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-5348
Practice Address - Country:US
Practice Address - Phone:562-500-6246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider