Healthcare Provider Details

I. General information

NPI: 1528202892
Provider Name (Legal Business Name): LEE ANNE C. WALSH R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2009
Last Update Date: 06/22/2020
Certification Date: 06/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2292 FARADAY AVE
CARLSBAD CA
92008-7238
US

IV. Provider business mailing address

2292 FARADAY AVE
CARLSBAD CA
92008-7238
US

V. Phone/Fax

Practice location:
  • Phone: 760-884-9868
  • Fax: 760-692-4818
Mailing address:
  • Phone: 760-884-9868
  • Fax: 760-730-7451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: