MR. PAUL DAVID WALLACE (NPI# 1114044799) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114044799 |
| Entity Type | Individual |
| Full Name | MR. PAUL DAVID WALLACE |
| Practice Address |
1212 N California St Stockton CA 95202-1552 |
| Practice Telephone | 2094683760 |
| Mailing Telephone | 2094683760 |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 167G00000X | Licensed Psychiatric Technician | PT 26296 | CA | Nursing Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629054598 | Paul Wayne Wallace | Pharmacist | 315 Mlk Way, Tacoma, WA 98405 | 2005-12-21 |
| 1265991335 | Paul Michael Wallace | Psychiatry & Neurology | 401 Parnassus Ave, San Francisco, CA 94143-0984 | 2019-03-18 |
| 1669794764 | Paul John Wallace | Pharmacist | 1993 Dickerson Blvd, Monroe, NC 28110-2795 | 2010-02-17 |
| 1548444318 | Paul S Wallace | Licensed Practical Nurse | 513 Se Quapaw, Bartlesville, OK 74003 | 2007-12-28 |
| 1770649741 | Paul D Wallace | Dentist | 8305 Walnut Hill Ln, Suite 235, Dallas, TX 75231-4217 | 2006-12-27 |
| 1639287212 | Paul Wallace | Internal Medicine | 3400 Spruce St, 5 Maloney, Philadelphia, PA 19104-4238 | 2006-08-25 |
| 1306875869 | Paul R. Wallace | Family Medicine | 1301 2nd Ave Sw, Largo, FL 33770-3120 | 2006-06-30 |
| 1063494474 | Paul Wesley Wallace | Dermatology | 8920 Wilshire Blvd, Suite 327, Beverly Hills, CA 90211-2007 | 2005-11-19 |
| Street Address |
1212 N CALIFORNIA ST |
| City | STOCKTON |
| State | CA |
| Zip Code | 95202-1552 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972592939 | Jin R. Soofi | Psychiatry & Neurology | 1212 N California St, Stockton, CA 95202-1552 | 2005-10-20 |
| 1750981437 | Matthew Robin Devera | Licensed Psychiatric Technician | 1212 N California St, Stockton, CA 95202-1552 | 2020-10-30 |
| 1609475581 | Bailey T Manego | Recreational Therapist Assistant | 1212 N California St, Stockton, CA 95202-1552 | 2020-10-21 |
| 1265039226 | Zachary Hensley | Marriage & Family Therapist | 1212 N California St, Stockton, CA 95202-1552 | 2020-10-02 |
| 1508477662 | Danielle Wiseman | Counselor | 1212 N California St, Stockton, CA 95202-1552 | 2020-08-12 |
| 1073121414 | Criselle Jane Carillo Sumampong | Licensed Psychiatric Technician | 1212 N California St, Stockton, CA 95202-1552 | 2020-07-22 |
| 1477161396 | Meliza Ann Agpaoa Ruiz | Licensed Psychiatric Technician | 1212 N California St, Stockton, CA 95202-1552 | 2020-07-16 |
| 1124646815 | Maria Truong | Counselor | 1212 N California St, Stockton, CA 95202-1552 | 2020-07-08 |
| 1871110437 | Victoria Lynn Phillips | Social Worker | 1212 N California St, Stockton, CA 95202-1552 | 2020-06-30 |
| 1730702119 | Jennifer J Salon | Licensed Psychiatric Technician | 1212 N California St, Stockton, CA 95202-1552 | 2020-05-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336774678 | Lecletus Griffin Jr. | Counselor | 1212 N. Califronia Street, Stockton, CA 95202 | 2020-03-06 |
| 1861035586 | Andrea Mn Perkins | Social Worker | Sjc Bhs Bacop, 1149 El Dorado Street, Stockton, CA 95202 | 2019-10-25 |
| 1932664620 | San Joaquin County Behavioral Health Services | Community/Behavioral Health | 1212 N. Califorian St, Stockton, CA 95202 | 2019-02-06 |
| 1730655895 | Jenaiah La'neise Sauceda | Social Worker | 343 E Main St Ste 918, Stockton, CA 95202 | 2018-10-16 |
| 1235631722 | Parker Yang | Counselor | 1111 N. El Dorado St, Stockton, CA 95202 | 2018-03-01 |
| 1912406976 | Janet Mendoza | Social Worker | 6 South Eldorado Street, Stockton, CA 95202 | 2018-02-06 |
| 1487162087 | Linda Soun | Counselor | 1111 N. El Dorado Street, Stockton, CA 95202 | 2018-01-17 |
| 1124545355 | Suleyma Velesquez | Counselor | 445 N. San Joaquin St., Stockton, CA 95202 | 2017-08-28 |
| 1821513946 | Savoeun Phal | Counselor | 1212 N California St Ste A214, Stockton, CA 95202 | 2017-08-09 |
| 1861921272 | Mandeep K Minhas | Registered Nurse | 1212 California St, Stockton, CA 95202 | 2017-06-08 |
| Find all providers in zip 95202 | ||||
| Taxonomy Code | 167G00000X |
| Grouping | Nursing Service Providers |
| Classification | Licensed Psychiatric Technician |
| An individual licensed by the state board as a Psychiatric Technician based upon completion of a prescribed course of theory and clinical practice, with two thirds of the clinical practice time focused on mental and developmental disorders. The psychiatric technician practices under the direct supervision of a physician, psychologist, registered nurse or other professional to provide care to patients with mental disorders and developmental disabilities. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114530250 | Heather Elizabeth Phillips | Licensed Psychiatric Technician | 4900 N Highway 99 Unit 68, Stockton, CA 95212-1007 | 2020-08-28 |
| 1093337511 | Christine Ann Scheuermann | Licensed Psychiatric Technician | 1447 Report Ave, Stockton, CA 95205-3030 | 2020-05-07 |
| 1609336882 | Monica Fuentes-rodriguez | Licensed Psychiatric Technician | 7000 N Michael Canlis Blv, Stockton, CA 95206 | 2019-03-22 |
| 1497167530 | Elizabeth Anne Degravio | Licensed Psychiatric Technician | 10904 Lands End Dr, Stockton, CA 95209-4289 | 2014-05-23 |
| 1801215082 | Ashlee Nicole Torres | Licensed Psychiatric Technician | 231 E Bianchi Rd, Stockton, CA 95207-7430 | 2014-04-15 |
| 1366884058 | Jill Siador | Licensed Psychiatric Technician | 3731 Carly Dr, Stockton, CA 95205-2589 | 2013-07-23 |
| 1477809929 | Milagros Moreno Mcarthur | Licensed Psychiatric Technician | 10834 Copperopolis Rd, Stockton, CA 95215-1741 | 2012-08-01 |
| 1033485495 | Thuy Huynh | Licensed Psychiatric Technician | 4545 Georgetown Place Suite A3, Stockton, CA 95207 | 2012-03-29 |
| 1124232665 | Lyndsey Marie Socha | Licensed Psychiatric Technician | 1947 N California St Ste C, Stockton, CA 95204-6029 | 2007-05-10 |
| 1851515092 | Barbara Franklin | Licensed Psychiatric Technician | 4514 Mcgaw St Apt 2, Stockton, CA 95207-8119 | 2007-04-12 |
| Find all providers in STOCKTON | ||||
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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.