Basic Information
| Provider Information | |||||||||
| NPI: | 1609185982 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WALKER | ||||||||
| FirstName: | DU' RON | ||||||||
| MiddleName: | LA MAR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 803 N NORTHWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | COMPTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902201638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5624432493 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3430 COGSWELL RD | ||||||||
| Address2: | |||||||||
| City: | EL MONTE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917322785 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6264533406 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2010 | ||||||||
| LastUpdateDate: | 09/09/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225400000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner | 101YA0400X | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.