MEDICARE: DR. WALTER CRUCE SAUNDERS JR. PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY006301	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PSY006301	OTHER	CA	CA LICENSE NUMBER

General Provider Information

NPI Number	:	1104821230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WALTER CRUCE SAUNDERS JR. PH.D.

Provider Business Mailing Address
First Line	:	7861 PRESTWICK CIR
Second Line	:	STE A
City	:	SAN JOSE
State	:	CA
Zip	:	95135-2143
Country	:	US
Telephone Number	:	408-270-0165
Fax Number	:	408-270-0166

Provider Business Practice Location Address
First Line	:	7861 PRESTWICK CIR
Second Line	:	STE A
City	:	SAN JOSE
State	:	CA
Zip	:	95135-2143
Country	:	US
Telephone Number	:	408-270-0165
Fax Number	:	408-270-0166

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	07/08/2007

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