MEDICARE: LEE ANNE C. WALSH R.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1528202892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEE ANNE C. WALSH R.D.

Provider Business Mailing Address
First Line	:	2292 FARADAY AVE
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92008-7238
Country	:	US
Telephone Number	:	760-884-9868
Fax Number	:	760-730-7451

Provider Business Practice Location Address
First Line	:	2292 FARADAY AVE
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92008-7238
Country	:	US
Telephone Number	:	760-884-9868
Fax Number	:	760-692-4818

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2009
Last Update Date	:	06/22/2020

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