Healthcare Provider Details

I. General information

NPI: 1780907865
Provider Name (Legal Business Name): SYDNEY ANNETTE BEBB-WALKER L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SYDNEY ANNETTE WALKER L.AC.

II. Dates (important events)

Enumeration Date: 03/03/2010
Last Update Date: 03/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 GRAVENSTEIN HWY S
SEBASTOPOL CA
95472-4851
US

IV. Provider business mailing address

5180 SONOMA MOUNTAIN RD
SANTA ROSA CA
95404-8881
US

V. Phone/Fax

Practice location:
  • Phone: 707-217-5777
  • Fax:
Mailing address:
  • Phone: 707-544-8802
  • Fax: 707-544-8802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberCA3545
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: