Provider Demographics
NPI:1972914224
Name:WALDEN, DAVID ALEXANDER (ATC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ALEXANDER
Last Name:WALDEN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2227 BANCROFT WAY
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94720-4426
Mailing Address - Country:US
Mailing Address - Phone:510-642-4801
Mailing Address - Fax:510-643-0792
Practice Address - Street 1:2227 BANCROFT WAY
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94720-4426
Practice Address - Country:US
Practice Address - Phone:510-642-4801
Practice Address - Fax:510-643-0792
Is Sole Proprietor?:No
Enumeration Date:2014-05-08
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE077916146N00000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic