Provider Demographics
NPI:1962698373
Name:WALTER, LAURA LOUISE (LAC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:LOUISE
Last Name:WALTER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 WINDHAM ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-2464
Mailing Address - Country:US
Mailing Address - Phone:831-706-6616
Mailing Address - Fax:
Practice Address - Street 1:4245 CAPITOLA RD
Practice Address - Street 2:SUITE 101
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-3573
Practice Address - Country:US
Practice Address - Phone:831-706-6616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 6940171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist