Provider Demographics
NPI:1447434055
Name:WALKER, RENEE MARNI (LAC)
Entity type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:MARNI
Last Name:WALKER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MRS
Other - First Name:RENEE
Other - Middle Name:MARNI
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:11515 EL CAMINO REAL
Mailing Address - Street 2:SUITE 160
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-3038
Mailing Address - Country:US
Mailing Address - Phone:858-792-7611
Mailing Address - Fax:858-356-0412
Practice Address - Street 1:11515 EL CAMINO REAL
Practice Address - Street 2:SUITE 160
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-3038
Practice Address - Country:US
Practice Address - Phone:858-792-7611
Practice Address - Fax:858-356-0412
Is Sole Proprietor?:No
Enumeration Date:2007-12-19
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8796171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist