ANDREA SHANWTRAE WALLACE


Address: 2130 N Arrowhead Ave Ste 205b-1c, San Bernardino, CA 92405-4029
Phone: 6615246038

ANDREA SHANWTRAE WALLACE (NPI# 1154976777) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1154976777
Entity Type Individual
Full Name ANDREA SHANWTRAE WALLACE
Practice Address 2130 N Arrowhead Ave Ste 205b-1c
San Bernardino
CA 92405-4029
Practice Telephone 6615246038
Mailing Telephone 6615246038
Enumeration Date 2019-08-09
Last Update Date 2019-08-09
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 171WV0202X Contractor
Specialization: Vehicle Modifications
D6516086 CA Other Service Providers

Other Provider Identifier

State Issuer Identifier Type Code
CA 90934505A95133 05

Provider Secondary Practice Location

Address Telephone Number Fax Number
1737 E G St Apt 39, Ontario, CA 917645428 6619415028

Other Providers ANDREA WALLACE

NPI Name Taxonomy Address Enumeration
1871608604 Andrea L Wallace Dentist 2003 S Plaza Rd, Emmett, ID 83617-9180 2006-08-20
1083264485 Andrea Namon Wallace Student in an Organized Health Care Education/Training Program 9808 Venice Blvd Ste 700, Culver City, CA 90232-6824 2019-09-17
1417455809 Andrea Wallace Nurse Practitioner 7810 Providence Rd, Ste 102, Charlotte, NC 28226-2954 2018-01-31
1902116122 Andrea Wallace Physical Therapist 1231 Pine Grove Ave, Suite 1a, Port Huron, MI 48060-3500 2010-10-21
1326166315 Andrea Yvonne Wallace Physical Therapy Assistant 3 Merit Dr, Richmond Heights, OH 44143-1457 2007-03-27
1396819884 Andrea Lynn Wallace Audiologist 7373 West Ln, Stockton, CA 95210-3377 2006-11-17
1669491171 Andrea S Wallace Internal Medicine 101 Manning Dr, Chapel Hill, NC 27599-0001 2006-07-18

Office Location

Street Address 2130 N ARROWHEAD AVE STE 205B-1C
City SAN BERNARDINO
State CA
Zip Code 92405-4029

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1174177497 New Hope Transitional Living Clinical Nurse Specialist 1228 West 31st, San Bernardino, CA 92405 2019-07-25
1336647494 Paul J Iorio Counselor 1669 Norht E Street, San Bernardino, CA 92405 2018-01-24
1609385756 Abraham Isacc Gonzalez Registered Nurse 255 W 17th St, San Bernardino, CA 92405 2017-09-20
1962945675 Ann Marie Monica Clark Assisted Living Facility 3524 Acacia Avenue, San Bernardino, CA 92405 2016-11-29
1801265715 Leslie Del Toro Counselor 2025 N D St, San Bernardino, CA 92405 2015-09-21
1558797324 Nora Escobar-mandujano Marriage & Family Therapist 1441 North 'd' Street, San Bernardino, CA 92405 2013-09-24
1295088284 Elizabeth Rocha Counselor 1669 North E Street, San Bernardino, CA 92405 2012-10-16
1972855237 Vanessa Kelly Gutierrez Marriage & Family Therapist 1669 N E Street, San Bernardino, CA 92405 2012-10-11
1952664021 Mosley Counseling Center, LLC Counselor 2130 W. Arrowhead Ave., Suite 103c, San Bernardino, CA 92405 2012-06-22
1508167602 Al Shifa Clinic Incorporated Voluntary or Charitable 2334 North Sierra Way, San Bernardino, CA 92405 2010-11-06
Find all providers in zip 92405

Taxonomy Information

Taxonomy Code 171WV0202X
Grouping Other Service Providers
Classification Contractor
Specialization Vehicle Modifications

Taxonomy Definition

A contractor who makes modifications to private vehicles to accommodate a health condition.

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1972129658 Clifford R Villaflor Sr. Contractor 18800 Amar Rd Ste B16, Walnut, CA 91789-7101 2020-06-18
1306483193 Charlemagne Previlon Contractor 4323 Carmelo Oaks Ct, Sacramento, CA 95841-3474 2019-11-29
1285291161 Samvel Abramov Contractor 6470 Foothill Blvd # J, Tujunga, CA 91042-2729 2019-05-25
1093267122 Ericson Araullo Contractor 9372 Meridian Ln, Garden Grove, CA 92841-1260 2016-10-24
1437508389 Anna Gavin Contractor 1256 W. Lathrop Rd #376, Manteca, CA 95336 2016-06-10
1619334976 Eyad Totah Contractor 15583 Budge St, San Leandro, CA 94579-2305 2016-01-18
1326411356 U2mobility, Inc. Contractor 850 E. Parkridge Ave, #107, Corona, CA 92879-6613 2015-11-13
1063955599 Fiorella Yong Contractor 601 E 7th St, Hanford, CA 93230-4665 2016-12-01
1215246806 Dennis Lloyd Brewer Contractor 1281 Andersen Dr Ste F, San Rafael, CA 94901-5335 2010-09-29

Competitor

Search similar providers

City SAN BERNARDINO
Zip Code 92405

Improve Information

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Dataset Information

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.

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