Individual
BRENT WALTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
CALIFORNIA MENS COLONY, N. HIGHWAY 1, SAN LUIS OBISPO, CA 93409-0001
(805) 547-7900
Mailing address
CALIFORNIA MENS COLONY, PO BOX 8101, N. HIGHWAY 1, SAN LUIS OBISPO, CA 93409-0001
(805) 547-7900
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
G72406
CA
Other
Enumeration date
12/09/2008
Last updated
12/09/2008
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