Provider Demographics
NPI:1386755767
Name:WALSH, JILL (MD)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:WALSH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6555 COYLE AVE
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-0302
Practice Address - Country:US
Practice Address - Phone:916-536-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG66619208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG66619OtherBLUE CROSS
CA00G666190Medicaid
CA7038199OtherCIGNA
CA1232511OtherUNITED HEALTHCARE
CA029615OtherHEALTH NET
CA94382OtherFIRST HEALTH
CA19708OtherINTERPLAN
CA5914451OtherAETNA
CA546782OtherGREAT WEST
CA000810564975OtherPHCS
CA90073071OtherPACIFICARE
CAMCMG118100OtherWESTERN HEALTH ADVANTAGE
CA029615OtherHEALTH NET
CA1232511OtherUNITED HEALTHCARE