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NPI Code Detail

MEDICARE: LISA WALTER RADT

MEDICARE: LISA WALTER RADT
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
1175T00000XPeer Specialist

General Provider Information

NPI Number : 1932824158
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA WALTER RADT
Provider Business Mailing Address
First Line : 3594 4TH AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92103-4989
Country : US
Telephone Number : 619-296-1151
Fax Number : 619-296-1151
Provider Business Practice Location Address
First Line : 3594 4TH AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92103-4989
Country : US
Telephone Number : 619-296-1151
Fax Number : 619-296-1151
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2022
Last Update Date : 10/10/2022

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Directions to “ LISA WALTER RADT” Practice Location

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