MRS. DEBRA ANN WALLACE FNP NPI 1770006538

NPI Information

NPI: 1770006538
Provider Name: MRS. DEBRA ANN WALLACE, FNP
Classification: Surgery - 2086S0122X
Entity Type: Individual

Specialization: Plastic and Reconstructive Surgery

Address:
1100 N STATE STREET
CLINIC TOWER A6A231A
LOS ANGELES, CA
ZIP 90033
Phone: (323) 409-7788
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MRS. Debra Ann Wallace, FNP is a plastic and reconstructive surgery surgery in Los Angeles, CA. The provider is a surgeon who specializes in plastic and reconstructive surgery. MRS. Debra Ann Wallace, FNP NPI is 1770006538. The provider is registered as an individual entity type and is a multi-specialty group.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

1100 N STATE STREET
CLINIC TOWER A6A231A
LOS ANGELES, CA
ZIP 90033
Phone: (323) 409-7788
Fax: (323) 441-7298

The enumeration date for this NPI number is 7/24/2017 and was last updated on 6/16/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2086S0122X	Surgery	Plastic and Reconstructive Surgery	8326	CALIFORNIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	$$$$$$$$$	OTHER	CALIFORNIA	MEDICARE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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