Active NPI
William Valdivia-Mairesse, PSY.D
- Psychologist
- Los Angeles, CA
National Provider Identifier
1245460070
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY24368
- Practice address
- 12400 Wilshire Blvd
Ste. 230
Los Angeles, CA 90025-1019 - Phone
- (424) 229-1838
- Fax
- (310) 399-9358
- NPI assigned
- Jul 14, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY24368 | CA | Primary |
Addresses
Primary practice location
12400 Wilshire Blvd
Ste. 230
Los Angeles, CA 90025-1019
Mailing address
12400 Wilshire Blvd
Ste. 230
Los Angeles, CA 90025-1019
Phone (424) 229-1838
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY24368 | CA | MD | Psychologist |
| 24368 | CA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1247529600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1378771200000",
"number": "1245460070",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12400 WILSHIRE BLVD",
"address_2": "STE. 230",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900251019",
"telephone_number": "424-229-1838",
"fax_number": "310-399-9358"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12400 WILSHIRE BLVD",
"address_2": "STE. 230",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900251019",
"telephone_number": "424-229-1838",
"fax_number": "310-399-9358"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VALDIVIA-MAIRESSE",
"first_name": "WILLIAM",
"name_prefix": "Mr.",
"credential": "PSY.D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-07-14",
"last_updated": "2013-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY24368",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.