Healthcare Provider Details

I. General information

NPI: 1811375447
Provider Name (Legal Business Name): DARRELL WALTERS PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2015
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1137 2ND ST STE 216
SANTA MONICA CA
90403-5077
US

IV. Provider business mailing address

1137 2ND ST STE 216
SANTA MONICA CA
90403-5077
US

V. Phone/Fax

Practice location:
  • Phone: 310-699-8650
  • Fax:
Mailing address:
  • Phone: 310-699-8650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number33348
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number33348
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: