Provider Demographics
NPI:1144703828
Name:WALTER, CURTIS FRED (RCP)
Entity type:Individual
Prefix:
First Name:CURTIS
Middle Name:FRED
Last Name:WALTER
Suffix:
Gender:M
Credentials:RCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8264 PEBBLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92880-1063
Mailing Address - Country:US
Mailing Address - Phone:951-313-0019
Mailing Address - Fax:
Practice Address - Street 1:1 HOAG DR
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4162
Practice Address - Country:US
Practice Address - Phone:949-764-4624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA241572279P3900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279P3900XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredNeonatal/Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA24157OtherCALIFORNIA BOARD OF RESPIRATORY CARE
CA98099OtherNATIONAL BOARD OF RESPIRATORY CARE