Provider Demographics
NPI:1104548403
Name:WALKER, CINTHIA IRENE (PMHNP)
Entity type:Individual
Prefix:
First Name:CINTHIA
Middle Name:IRENE
Last Name:WALKER
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17427 WELLFLEET AVE
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-1656
Mailing Address - Country:US
Mailing Address - Phone:323-326-4160
Mailing Address - Fax:
Practice Address - Street 1:1401 N EL CAMINO REAL STE 100
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-4983
Practice Address - Country:US
Practice Address - Phone:858-522-0145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-13
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95021309363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health