WALLACE B CARROLL (NPI# 1003874124) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003874124 |
| Entity Type | Individual |
| Full Name | WALLACE B CARROLL |
| Credential | MD |
| Practice Address |
600 Coffee Rd Modesto CA 95355-4201 |
| Practice Telephone | 2095241211 |
| Mailing Telephone | 2095241211 |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2010-05-28 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207KA0200X |
Allergy & Immunology Specialization: Allergy |
A31444 | CA | Allopathic & Osteopathic Physicians |
| N | 208000000X | Pediatrics | A31444 | CA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | 00A314440 | 05 |
| Street Address |
600 COFFEE RD |
| City | MODESTO |
| State | CA |
| Zip Code | 95355-4201 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073517751 | Kishore K. Kalluri | Internal Medicine | 600 Coffee Rd, Modesto, CA 95355-4201 | 2005-06-09 |
| 1508405622 | Erica Corral-ruiz | Registered Nurse | 600 Coffee Rd, Modesto, CA 95355-4201 | 2020-01-06 |
| 1598324519 | Cierra Coffman | Physician Assistant | 600 Coffee Rd, Modesto, CA 95355-4201 | 2019-06-12 |
| 1053879932 | Anitha Choorakulam George | Nurse Practitioner | 600 Coffee Rd, Modesto, CA 95355-4201 | 2019-03-09 |
| 1154852994 | Simran Kaur Bains | Internal Medicine | 600 Coffee Rd, Modesto, CA 95355-4201 | 2017-03-23 |
| 1891246153 | Pacific Infectious Diseases, Inc. | Internal Medicine | 600 Coffee Rd, Modesto, CA 95355-4201 | 2016-10-20 |
| 1497108062 | Palvasha Shah | Internal Medicine | 600 Coffee Rd, Modesto, CA 95355 | 2016-07-19 |
| 1861845430 | Bharati Meesala | Hospitalist | 600 Coffee Rd, Modesto, CA 95355-4201 | 2016-07-19 |
| 1376999672 | David William Lowry | Internal Medicine | 600 Coffee Rd, Modesto, CA 95355-4201 | 2016-05-05 |
| 1245692250 | Swathi S.b. Kari | Hospitalist | 600 Coffee Rd, Modesto, CA 95355-4201 | 2016-03-28 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982211793 | I To I LLC | Optometrist | 3401 Oakdale Rd, Ste 525, Modesto, CA 95355 | 2020-09-25 |
| 1205443116 | Altwal and Shelat Dds Inc | Dentist | 1317 Oakdale Road, Suite 310, Modesto, CA 95355 | 2020-09-24 |
| 1184255911 | Reeves, D.d.s. and Lavalley, D.d.s., A Dental Corporation | Clinic/Center | 3401 Oakdale Road, Suite 505, Modesto, CA 95355 | 2020-01-30 |
| 1487133856 | Natalie Vargas | Behavior Technician | 1317 Oakdale Road Suite 610, Modesto, CA 95355 | 2018-08-07 |
| 1871079152 | Jill H Fusia | Dietitian, Registered | 1404 Cordero Court, Modesto, CA 95355 | 2018-07-19 |
| 1043727514 | Emily Lauren Schaefer | Behavioral Analyst | 3425 Coffee Rd Ste C2, Modesto, CA 95355 | 2018-01-05 |
| 1376083691 | Hari Gnanasekeram, PC | Technician, Cardiology | 1303 Mable Avenu, Modesto, CA 95355 | 2017-03-06 |
| 1598139891 | Encompass Health Rehabilitation Hospital of Modesto, LLC | Rehabilitation Hospital | 1303 Mable Avenue, Modesto, CA 95355 | 2015-11-24 |
| 1013387844 | Diana Faith Kigenyi | Social Worker | 1225 Oakdale Road, Modesto, CA 95355 | 2015-10-06 |
| 1437530672 | Tzu Yi Wei | Acupuncturist | 2209 Coffee Road, Suite A, Modesto, CA 95355 | 2015-06-12 |
| Find all providers in zip 95355 | ||||
| Taxonomy Code | 207KA0200X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Allergy & Immunology |
| Specialization | Allergy |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063903201 | Nisha Ann Roy | Allergy & Immunology | 1923 Coffee Rd Ste 12, Modesto, CA 95355-2708 | 2018-05-23 |
| 1265812119 | Baz Allergy, Asthma & Sinus Center, Inc. | Allergy & Immunology | 1923 Coffee Road, 12c, Modesto, CA 95355-2708 | 2015-06-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366078743 | Rhonda J. Myers, M.d. | Allergy & Immunology | 4902 Irvine Center Dr Ste 108, Irvine, CA 92604-3334 | 2020-03-18 |
| 1619472024 | Professional Diagnostic Solutions Inc | Allergy & Immunology | 16940 Chatsworth St Unit 303, Granada Hills, CA 91344-5864 | 2018-03-27 |
| 1528570678 | Dossier Health Management | Allergy & Immunology | 138 N Brand Blvd Ste 200-106, Glendale, CA 91203-4614 | 2017-10-30 |
| 1467805358 | James Patrick Kemp | Allergy & Immunology | 15904 Cuyamaca Forest Rd, Julian, CA 92036-9641 | 2016-07-15 |
| 1528426053 | Allergy Asthma Sinusitis Medical Clinic Inc Divyang Trivedi | Allergy & Immunology | 11832 Rosecrans Ave # 200, Norwalk, CA 90650-4107 | 2016-01-28 |
| 1932564879 | Tri Valley Allergy | Allergy & Immunology | 1038 Murrieta Blvd Ste B, Livermore, CA 94550-4151 | 2015-12-18 |
| 1881074748 | Baz Allergy, Asthma & Sinus Center, Inc. | Allergy & Immunology | 1853 Lander Ave, Turlock, CA 95380-6240 | 2015-06-05 |
| 1972983815 | Baz Allergy, Asthma & Sinus Center, Inc. | Allergy & Immunology | 1415 Badger Flat Rd, A, Los Banos, CA 93635-8600 | 2015-06-05 |
| 1114340528 | Baz Allergy, Asthma & Sinus Center, Inc. | Allergy & Immunology | 360 E Yosemite Ave Ste 200, Merced, CA 95340-8201 | 2014-01-22 |
| 1902143696 | Baz Allergy, Asthma & Sinus Center, Inc. | Allergy & Immunology | 563 I Street, Reedley, CA 93654-2431 | 2013-01-15 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.