Provider Demographics
NPI:1164271904
Name:WALKER-SANCHEZ, MYKIYAA MARVELLA
Entity type:Individual
Prefix:
First Name:MYKIYAA
Middle Name:MARVELLA
Last Name:WALKER-SANCHEZ
Suffix:
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 1:2033 SAINT AUGUSTA LN
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-3371
Mailing Address - Country:US
Mailing Address - Phone:310-291-4047
Mailing Address - Fax:
Practice Address - Street 1:180 NEWPORT CENTER DR STE 270D
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-0907
Practice Address - Country:US
Practice Address - Phone:949-299-6340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program