Provider Demographics
NPI:1528202892
Name:WALSH, LEE ANNE C (RD)
Entity type:Individual
Prefix:
First Name:LEE ANNE
Middle Name:C
Last Name:WALSH
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2292 FARADAY AVE
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-7238
Mailing Address - Country:US
Mailing Address - Phone:760-884-9868
Mailing Address - Fax:760-730-7451
Practice Address - Street 1:2292 FARADAY AVE
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-7238
Practice Address - Country:US
Practice Address - Phone:760-884-9868
Practice Address - Fax:760-692-4818
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-29
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered