MEDICARE: KATHLEEN WALSH NMW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	176B00000X	Midwife	1574	CA

General Provider Information

NPI Number	:	1396828687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN WALSH NMW

Provider Business Mailing Address
First Line	:	425 N DATE ST
Second Line	:
City	:	ESCONDIDO
State	:	CA
Zip	:	92025-3413
Country	:	US
Telephone Number	:	760-737-2035
Fax Number	:	760-741-2782

Provider Business Practice Location Address
First Line	:	401 E VALLEY PKWY
Second Line	:
City	:	ESCONDIDO
State	:	CA
Zip	:	92025-3317
Country	:	US
Telephone Number	:	760-737-2020
Fax Number	:	760-741-9380

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	11/18/2021

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