Individual
TODD STEVEN WALLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1700 WESTWOOD BLVD, LOS ANGELES, CA 90024-5608
(310) 470-1752
(310) 234-6604
Mailing address
1700 WESTWOOD BLVD, LOS ANGELES, CA 90024-5608
(310) 470-1752
(310) 234-6604
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
35053497
OH
207Y00000X
Otolaryngology Physician
Primary
G39474
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000123641
UNICARE
OH
05
—
0812893
—
OH
01
—
2160298
CIGNA
OH
01
—
353535
WELLCARE
OH
01
—
736455
BUCKEYE COMMUNITY HEALTH
OH
01
—
R53497
SUMMACARE
OH
Enumeration date
08/23/2005
Last updated
12/21/2011
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