Provider Demographics
NPI:1881760890
Name:WALTER, MICHELE (MS, LAC)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:WALTER
Suffix:
Gender:F
Credentials:MS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3595 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-4803
Mailing Address - Country:US
Mailing Address - Phone:619-917-7472
Mailing Address - Fax:
Practice Address - Street 1:4683 MERCURY ST
Practice Address - Street 2:SUITE C
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-2423
Practice Address - Country:US
Practice Address - Phone:858-467-9893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 9051171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist