Healthcare Provider Details

I. General information

NPI: 1972528388
Provider Name (Legal Business Name): TAMARA LYNN WALL PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VA SAN DIEGO HEALTHCARE SYSTEM 3350 LA JOLLA VILLAGE DR.
SAN DIEGO CA
92161-0001
US

IV. Provider business mailing address

3350 LA JOLLA VILLAGE DR. VA SAN DIEGO HEALTHCARE SYSTEM
SAN DIEGO CA
92161
US

V. Phone/Fax

Practice location:
  • Phone: 858-552-8585
  • Fax: 858-552-7414
Mailing address:
  • Phone: 858-552-8585
  • Fax: 858-552-7414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY15385
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberPSY15385
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberPSY15385
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPSY15385
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY15385
License Number StateCA
# 6
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberPSY15385
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: