Active NPI
Brent Walta, M.D.
- Psychiatry Physician
- San Luis Obispo, CA
National Provider Identifier
1922243658
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- G72406
- Practice address
- California Mens Colony
N. Highway 1
San Luis Obispo, CA 93409-0001 - Phone
- (805) 547-7900
- NPI assigned
- Dec 9, 2008
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | G72406 | CA | Primary |
Addresses
Primary practice location
California Mens Colony
N. Highway 1
San Luis Obispo, CA 93409-0001
Mailing address
California Mens Colony
PO Box 8101, N. Highway 1
San Luis Obispo, CA 93409-0001
Phone (805) 547-7900
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G72406 | CA | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1228780800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1228780800000",
"number": "1922243658",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "CALIFORNIA MENS COLONY",
"address_2": "PO BOX 8101, N. HIGHWAY 1",
"city": "SAN LUIS OBISPO",
"state": "CA",
"postal_code": "934090001",
"telephone_number": "805-547-7900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "CALIFORNIA MENS COLONY",
"address_2": "N. HIGHWAY 1",
"city": "SAN LUIS OBISPO",
"state": "CA",
"postal_code": "934090001",
"telephone_number": "805-547-7900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALTA",
"first_name": "BRENT",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-12-09",
"last_updated": "2008-12-09",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "CA",
"license": "G72406",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Luis Obispo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.