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General NPI Number Information
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NPI Number | 1245460070
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Entity Type | Individual
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Provider Name | WILLIAM VALDIVIA-MAIRESSE PSY.D
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Gender | Male
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Dates
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Enumeration Date | 07/14/2009
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Last Update Date | 09/10/2013
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Provider Practice Location Address
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Address Line | 12400 WILSHIRE BLVD STE. 230
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City | LOS ANGELES
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State | CA
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Zip | 90025-1019
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Country | US
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Telephone | 424-229-1838
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Fax | 310-399-9358
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Provider Business Mailing Address
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Address Line | 12400 WILSHIRE BLVD STE. 230
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City | LOS ANGELES
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State | CA
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Zip | 90025-1019
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Country | US
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Telephone | 424-229-1838
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Fax | 310-399-9358
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY24368
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License Number State | CA
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