Provider Demographics
NPI:1942505607
Name:WALTON, ZOE (LAC)
Entity Type:Individual
Prefix:MS
First Name:ZOE
Middle Name:
Last Name:WALTON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:ZOE
Other - Middle Name:
Other - Last Name:MANNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:830 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3254
Mailing Address - Country:US
Mailing Address - Phone:415-456-8435
Mailing Address - Fax:415-883-2398
Practice Address - Street 1:830 5TH AVE
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3254
Practice Address - Country:US
Practice Address - Phone:415-456-8435
Practice Address - Fax:415-883-2398
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC2969171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist