Healthcare Provider Details

I. General information

NPI: 1124179650
Provider Name (Legal Business Name): LISA WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 W VALERIO ST
SANTA BARBARA CA
93101-2930
US

IV. Provider business mailing address

283 ELLWOOD BEACH DR #12
GOLETA CA
93117-2762
US

V. Phone/Fax

Practice location:
  • Phone: 805-682-9917
  • Fax:
Mailing address:
  • Phone: 805-637-6369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: