Provider Demographics
NPI:1972796795
Name:WALKER, SIDNEY L (LIC AC)
Entity type:Individual
Prefix:
First Name:SIDNEY
Middle Name:L
Last Name:WALKER
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012A DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94709-2122
Mailing Address - Country:US
Mailing Address - Phone:510-540-5908
Mailing Address - Fax:
Practice Address - Street 1:1654 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94703-1455
Practice Address - Country:US
Practice Address - Phone:510-540-5908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA313171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist