LA TANYA WALLACE FNP NPI 1841453487

NPI Information

NPI: 1841453487
Provider Name: LA TANYA WALLACE, FNP
Classification: Nurse Practitioner - 363LP0808X
Entity Type: Individual

Specialization: Psychiatric/Mental Health

PECOS Registration: Yes

Address:
6921 SPERRY CT
SAN DIEGO, CA
ZIP 92111
Phone: (858) 717-0164
Get Directions

La Tanya Wallace, FNP is a psychiatric/mental health nurse practitioner in San Diego, CA with 12 years of experience. La Tanya Wallace, FNP NPI is 1841453487. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

Education
Medical School: WESTERN UNIVERSITY OF HEALTH SCIENCES COLLEGE OF DENTAL MED
Graduation Year:2012

The provider's business location address is:

6921 SPERRY CT
SAN DIEGO, CA
ZIP 92111-030
Phone: (858) 717-0164
Fax: (888) 425-0508

The NPI 1841453487 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 7/3/2008 and was last updated on 1/28/2024.

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	163W00000X	Registered Nurse		680663	CALIFORNIA	No
2	363L00000X	Nurse Practitioner		22485	CALIFORNIA	No
3	363LF0000X	Nurse Practitioner	Family	680663	CALIFORNIA	No
4	363LF0000X	Nurse Practitioner	Family	22485	CALIFORNIA	No
5	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health	22485	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	680663	OTHER	CALIFORNIA	CA BRN
2	22485	OTHER	CALIFORNIA	BOARD OF REGISTERED NURSING

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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