Basic Information
Provider Information
NPI: 1508363987
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WALKER
FirstName: AMELIA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5767 W CENTURY BLVD STE 400
Address2:  
City: LOS ANGELES
State: CA
PostalCode: 900455631
CountryCode: US
TelephoneNumber: 3103018807
FaxNumber: 3103018751
Practice Location
Address1: 200 UCLA MEDICAL PLZ STE 265
Address2:  
City: LOS ANGELES
State: CA
PostalCode: 900951752
CountryCode: US
TelephoneNumber: 3108250867
FaxNumber: 3107945066
Other Information
ProviderEnumerationDate: 04/11/2018
LastUpdateDate: 05/12/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/12/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208000000XA165304CAY Allopathic & Osteopathic PhysiciansPediatrics 

No ID Information.


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