Provider Demographics
NPI:1396921573
Name:WALTON, BRANDIE RULFS (PA-C)
Entity type:Individual
Prefix:MRS
First Name:BRANDIE
Middle Name:RULFS
Last Name:WALTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:PO BOX 1874
Mailing Address - Street 2:
Mailing Address - City:SUISUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94585-4874
Mailing Address - Country:US
Mailing Address - Phone:657-241-3600
Mailing Address - Fax:657-241-7708
Practice Address - Street 1:19361 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-2503
Practice Address - Country:US
Practice Address - Phone:714-960-4500
Practice Address - Fax:714-960-7133
Is Sole Proprietor?:No
Enumeration Date:2008-01-17
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA13255363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant