Provider Demographics
NPI:1730175449
Name:WALTER, DAVID H (PHD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:H
Last Name:WALTER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11728 WILSHIRE BLVD
Mailing Address - Street 2:STE B-306
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-6473
Mailing Address - Country:US
Mailing Address - Phone:310-479-2512
Mailing Address - Fax:626-918-5487
Practice Address - Street 1:1840 N HACIENDA BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91744-1143
Practice Address - Country:US
Practice Address - Phone:626-919-8493
Practice Address - Fax:626-918-5487
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8719103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY087191Medicaid
CAPSY087192Medicaid
CAPSY087192Medicaid