Healthcare Provider Details

I. General information

NPI: 1730175449
Provider Name (Legal Business Name): DAVID H WALTER PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 N HACIENDA BLVD SUITE 2
LA PUENTE CA
91744-1143
US

IV. Provider business mailing address

11728 WILSHIRE BLVD STE B-306
LOS ANGELES CA
90025-6473
US

V. Phone/Fax

Practice location:
  • Phone: 626-919-8493
  • Fax: 626-918-5487
Mailing address:
  • Phone: 310-479-2512
  • Fax: 626-918-5487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY8719
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: