Provider Demographics
NPI:1366175481
Name:WALSTON, JULIA (AA)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:WALSTON
Suffix:
Gender:F
Credentials:AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3528 DEL AMO BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-3034
Mailing Address - Country:US
Mailing Address - Phone:310-707-5581
Mailing Address - Fax:
Practice Address - Street 1:3680 E IMPERIAL HWY STE 504
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-2659
Practice Address - Country:US
Practice Address - Phone:310-807-7545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty