Provider Demographics
NPI:1174614994
Name:SILVA, WALTER NMN (MD)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:NMN
Last Name:SILVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 MAGNOLIA AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879
Mailing Address - Country:US
Mailing Address - Phone:951-735-9211
Mailing Address - Fax:959-735-9299
Practice Address - Street 1:341 MAGNOLIA AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879
Practice Address - Country:US
Practice Address - Phone:951-735-9211
Practice Address - Fax:959-735-9299
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41479207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8036117Medicaid
CA8036117Medicaid
00A414790Medicare ID - Type Unspecified