Provider Demographics
NPI:1073686481
Name:WALDEN, ANNA C (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:C
Last Name:WALDEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7548 SANTA MONICA AVE.
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92167-0548
Mailing Address - Country:US
Mailing Address - Phone:619-733-1691
Mailing Address - Fax:619-756-6456
Practice Address - Street 1:991 AMIFORD DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92107-4207
Practice Address - Country:US
Practice Address - Phone:619-733-1691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7846103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7846AMedicare ID - Type Unspecified