Provider Demographics
NPI:1962566380
Name:WALSH, PATRICK JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:JOSEPH
Last Name:WALSH
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Gender:M
Credentials:MD
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Mailing Address - Street 1:15243 VANOWEN ST.
Mailing Address - Street 2:SUITE #411
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-3661
Mailing Address - Country:US
Mailing Address - Phone:818-787-1050
Mailing Address - Fax:818-787-9072
Practice Address - Street 1:15243 VANOWEN ST.
Practice Address - Street 2:SUITE #411
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-3661
Practice Address - Country:US
Practice Address - Phone:818-787-1050
Practice Address - Fax:818-787-9072
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2009-01-06
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Provider Licenses
StateLicense IDTaxonomies
CAG279682279P1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279P1004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredPulmonary Diagnostics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA43558Medicare UPIN