Todd Steven Waller, M.D.

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

G39474 Issued in CA

Practice address

1700 Westwood Blvd
Los Angeles, CA 90024-5608

Phone

(310) 470-1752

Fax

(310) 234-6604

NPI assigned

Aug 23, 2005

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 7

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

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  • NPI 1689973638
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1124755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1324425600000",
    "number": "1306839568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 WESTWOOD BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900245608",
            "telephone_number": "310-470-1752",
            "fax_number": "310-234-6604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 WESTWOOD BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900245608",
            "telephone_number": "310-470-1752",
            "fax_number": "310-234-6604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLER",
        "first_name": "TODD",
        "middle_name": "STEVEN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-23",
        "last_updated": "2011-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "OH",
            "license": "35053497",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "CA",
            "license": "G39474",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BUCKEYE COMMUNITY HEALTH",
            "identifier": "736455",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SUMMACARE",
            "identifier": "R53497",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNICARE",
            "identifier": "000000123641",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0812893",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE SHIELD",
            "identifier": "000000123641",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "2160298",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE",
            "identifier": "353535",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Suzanne Marie Wallach, LMFT
• Agnes Soriano Wallbom, M.D., M.S.
• Drew Alan Walleck, ESQ.
• Donald E. Wallens, M.D.
• Jonathan M Waller, MA CCC-SLP
• Wynton Wallers
• Derek Wallin, D.D.S.
• Benjamin William Walline, DDS, MD
• Anne Walling, MD
• Christopher Glenn Walling, PSYD

• Otolaryngology Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Otolaryngology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.