Provider Demographics
NPI:1871280669
Name:WALKMAN, SAMIR (PMHNP-BC, MSN, RN)
Entity type:Individual
Prefix:MR
First Name:SAMIR
Middle Name:
Last Name:WALKMAN
Suffix:
Gender:M
Credentials:PMHNP-BC, MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 ANTIQUE ROSE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-4802
Mailing Address - Country:US
Mailing Address - Phone:949-561-8720
Mailing Address - Fax:
Practice Address - Street 1:42923 N FORK DR
Practice Address - Street 2:
Practice Address - City:THREE RIVERS
Practice Address - State:CA
Practice Address - Zip Code:93271-9644
Practice Address - Country:US
Practice Address - Phone:949-561-8720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-20
Last Update Date:2025-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95302275163W00000X
CA95033911363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse