Healthcare Provider Details

I. General information

NPI: 1770988289
Provider Name (Legal Business Name): JANET WALTERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2014
Last Update Date: 10/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 BREAKAWAY DR
OCEANSIDE CA
92057-1955
US

IV. Provider business mailing address

1265 BREAKAWAY DR
OCEANSIDE CA
92057-1955
US

V. Phone/Fax

Practice location:
  • Phone: 760-696-8966
  • Fax:
Mailing address:
  • Phone: 760-696-8966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number613397
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number613397
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: