Provider Demographics
NPI:1821287087
Name:SVOBODA, WALTRAUD RUTH (L AC)
Entity Type:Individual
Prefix:MRS
First Name:WALTRAUD
Middle Name:RUTH
Last Name:SVOBODA
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 230479
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92023-0479
Mailing Address - Country:US
Mailing Address - Phone:858-776-1509
Mailing Address - Fax:
Practice Address - Street 1:345 S COAST HIGHWAY 101
Practice Address - Street 2:STE. F-2, C/O DE LA SOLEIL SKIN STUDIO
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3551
Practice Address - Country:US
Practice Address - Phone:858-776-1509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4771171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist