Healthcare Provider Details

I. General information

NPI: 1417173212
Provider Name (Legal Business Name): SALLY WALSH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3952 30TH ST
SAN DIEGO CA
92104-3005
US

IV. Provider business mailing address

3952 30TH ST
SAN DIEGO CA
92104-3005
US

V. Phone/Fax

Practice location:
  • Phone: 619-297-4145
  • Fax: 619-297-0237
Mailing address:
  • Phone: 619-297-4145
  • Fax: 619-297-0237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAU2222
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: