Individual
KEVIN WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
26910 SIERRA HWY STE D8, SANTA CLARITA, CA 91321-2262
(661) 857-5303
Mailing address
3031 CHOCTAW AVE, SIMI VALLEY, CA 93063-2051
(661) 857-5303
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
95037186
CA
Other
Enumeration date
04/04/2026
Last updated
04/04/2026
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