Marty Walter III, LVN

Primary specialty

Licensed Vocational NurseTaxonomy code 164X00000X

License

VN205110 Issued in CA

Practice address

550 N Flower St
Santa Ana, CA 92703-2361

Phone

(714) 647-6048

NPI assigned

Oct 15, 2013

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1381795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1381795200000",
    "number": "1104254994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "914 S SHERRILL ST",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928044025",
            "telephone_number": "714-952-8667"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 N FLOWER ST",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927032361",
            "telephone_number": "714-647-6048"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALTER",
        "first_name": "MARTY",
        "name_prefix": "Mr.",
        "name_suffix": "III",
        "credential": "LVN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-10-15",
        "last_updated": "2013-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164X00000X",
            "taxonomy_group": "",
            "desc": "Licensed Vocational Nurse",
            "state": "CA",
            "license": "VN205110",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Walmart Inc.
• Walmart, Inc.
• Diana Lyn Walsh
• Charistella Walter, NP
• Linda Walter
• Kayela Walters
• Rachel Walters
• Bridget Walton
• Tiffany Wambua, BCBA
• Wang and Jean D.M.D., Inc.

• Licensed Vocational Nurse in Santa Ana, CA
• Providers in Santa Ana, CA by specialty
• Licensed Vocational Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.