Provider Demographics
NPI:1376597914
Name:WALDER, DANIELA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DANIELA
Middle Name:
Last Name:WALDER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:554 S SAN VICENTE BLVD STE 108
Mailing Address - Street 2:SUITE D
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-4652
Mailing Address - Country:US
Mailing Address - Phone:310-228-8383
Mailing Address - Fax:
Practice Address - Street 1:554 S SAN VICENTE BLVD STE 108
Practice Address - Street 2:SUITE D
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4652
Practice Address - Country:US
Practice Address - Phone:310-228-8383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18702103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP18702Medicare ID - Type Unspecified