Healthcare Provider Details

I. General information

NPI: 1992228886
Provider Name (Legal Business Name): LLOYD EDWARD WALTON LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2017
Last Update Date: 07/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2372 ELLSWORTH ST STE E
BERKELEY CA
94704-1580
US

IV. Provider business mailing address

226 ATHOL AVE APT 208
OAKLAND CA
94606-1349
US

V. Phone/Fax

Practice location:
  • Phone: 510-549-3000
  • Fax:
Mailing address:
  • Phone: 562-331-3197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number17526
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: