Active NPI
Daniela Walder, PSYD
- Clinical Psychologist
- Los Angeles, CA
National Provider Identifier
1376597914
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY18702
- Practice address
- 554 S San Vicente Blvd Ste 108
Suite D
Los Angeles, CA 90048-4652 - Phone
- (310) 228-8383
- NPI assigned
- May 19, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY18702 | CA | Primary |
Addresses
Primary practice location
554 S San Vicente Blvd Ste 108
Suite D
Los Angeles, CA 90048-4652
Mailing address
554 S San Vicente Blvd Ste 108
Suite D
Los Angeles, CA 90048-4652
Phone (310) 228-8383
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 1, 2020 through Apr 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Vericare of California Medical Group | Clinical | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Clinical Psychologist
- Paradise, CA
- NPI 1316992829
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147996800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1356566400000",
"number": "1376597914",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "554 S SAN VICENTE BLVD STE 108",
"address_2": "SUITE D",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900484652",
"telephone_number": "310-228-8383"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "554 S SAN VICENTE BLVD STE 108",
"address_2": "SUITE D",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900484652",
"telephone_number": "310-228-8383"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALDER",
"first_name": "DANIELA",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-05-19",
"last_updated": "2012-12-27",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY18702",
"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 Dec 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.