Provider Demographics
NPI:1144271834
Name:WALTON PEDIATRICS AND MEDICAL ASSOCIATES, INC
Entity type:Organization
Organization Name:WALTON PEDIATRICS AND MEDICAL ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:WALTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-422-6635
Mailing Address - Street 1:7275 E SOUTHGATE DR
Mailing Address - Street 2:SUITE 306
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-2628
Mailing Address - Country:US
Mailing Address - Phone:916-422-6635
Mailing Address - Fax:916-422-2741
Practice Address - Street 1:7275 E SOUTHGATE DR
Practice Address - Street 2:SUITE 306
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2628
Practice Address - Country:US
Practice Address - Phone:916-422-6635
Practice Address - Fax:916-422-2741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF95642Medicare UPIN