Provider Demographics
NPI:1528102969
Name:WALKER, CECIL CLEMENT
Entity type:Individual
Prefix:MR
First Name:CECIL
Middle Name:CLEMENT
Last Name:WALKER
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:CECIL
Other - Middle Name:CLEMENT
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:20021 CLIVEDEN AVE
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-2526
Mailing Address - Country:US
Mailing Address - Phone:310-603-9820
Mailing Address - Fax:
Practice Address - Street 1:333 N PRAIRIE AVE
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-4501
Practice Address - Country:US
Practice Address - Phone:310-419-8246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA10186363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical