Provider Demographics
NPI:1497829170
Name:WALKER, LISA ANN (LAC)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:ANN
Last Name:WALKER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1346 FOOTHILL BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011-2122
Mailing Address - Country:US
Mailing Address - Phone:818-952-2781
Mailing Address - Fax:
Practice Address - Street 1:1346 FOOTHILL BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:LA CANADA
Practice Address - State:CA
Practice Address - Zip Code:91011-2122
Practice Address - Country:US
Practice Address - Phone:818-952-2781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 7687171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist