ERIC WALLACE


Address: 168 N Brent St, Suite 402, Ventura, CA 93003-2817
Phone: 8882340004

ERIC WALLACE (NPI# 1578502191) 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) 1578502191
Entity Type Individual
Full Name ERIC WALLACE
Credential MD
Practice Address 168 N Brent St
Suite 402
Ventura
CA 93003-2817
Mailing Address 4100 Guardian St
Ste 205
Simi Valley
CA 93063-6721
Practice Telephone 8882340004
Practice Fax Number 8056413965
Mailing Telephone 8555044544
Mailing Fax Number 8555772018
Enumeration Date 2006-06-06
Last Update Date 2017-11-14
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 2085R0202X Radiology
Specialization: Diagnostic Radiology
A85195 CA Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
CA BLUESHIELD OF CA 00A851950 01
CA 00A851950 05

Other Providers ERIC WALLACE

NPI Name Taxonomy Address Enumeration
1417183476 Eric T Wallace Physical Therapist W5361 County Road Kk Ste E, Appleton, WI 54915-7271 2009-06-04
1922218809 Eric Wallace Radiologic Technologist 4004 Landside Dr, Louisville, KY 40220-3020 2007-05-22
1871706960 Eric Wallace Emergency Medicine Paula Bldg 230, 728 Richard Arrington Blvd, Birmingham, AL 35294-0001 2007-05-07
1174665277 Eric H Wallace Dentist 28 Se 6th St, Boca Raton, FL 33432-6016 2007-02-13
1780614529 Eric L. Wallace Surgery 1450 Matthews Township Parkway, Suite 300, Matthews, NC 28105 2006-07-04
1912409160 Eric Wallace Psychologist 22001 Fairmount Blvd, Shaker Heights, OH 44118-4819 2018-03-05
1528333838 Eric Joseph Wallace Jr. Radiology 1542 Tulane Ave, Room 353, New Orleans, LA 70112-2865 2012-03-20
1568658243 Eric L Wallace Internal Medicine 700 W Ironwood Dr, 320, Coeur D Alene, ID 83814-2656 2007-09-17
1891838991 Eric Michael Wallace Dentist 1515 State St, Suite 9, Santa Barbara, CA 93101-2536 2007-02-15
1154434488 Eric Wallace Family Medicine 143 Longwater Dr, Norwell, MA 02061-1683 2006-08-17

Office Location

Street Address 168 N BRENT ST
SUITE 402
City VENTURA
State CA
Zip Code 93003-2817

Providers in the same location

NPI Name Taxonomy Address Enumeration
1013919133 Jeffrey C Brackett Internal Medicine 168 N Brent St, Ste 503, Ventura, CA 93003-2840 2005-06-01
1932731866 Sally F Mcnally Advanced Practice Midwife 168 N Brent St, Ventura, CA 93003-2817 2020-02-08
1710367693 Stephan Sweet, M.d. Inc. Orthopaedic Surgery 168 N Brent St, Ste 505, Ventura, CA 93003-2817 2015-06-04
1518363001 Robert T Mazurek M D A Professional Specialist 168 N Brent St, Suite 501, Ventura, CA 93003-2817 2014-11-10
1013312594 Antulio B Aroche Jr Do A Professional Corporation Orthopaedic Surgery 168 N Brent St, Suite 505, Ventura, CA 93003-2817 2014-10-27
1861738718 Diane Jeanne Milstead Advanced Practice Midwife 168 N Brent St, 407, Ventura, CA 93003-2817 2012-12-21
1699011569 Ventura County Neurosurgery Associates Medical Group Neurological Surgery 168 N Brent St, Suite 408, Ventura, CA 93003-2817 2012-12-21
1083950018 David L. Westra, Md, A Professional Corporation Neurological Surgery 168 N Brent St, Suite 408, Ventura, CA 93003-2817 2012-12-19
1164768107 Michael J Dorsi, M.d., A Professional Corporation Neurological Surgery 168 N Brent St, Suite 408, Ventura, CA 93003-2817 2012-12-19
1164766291 Tracy Ann Lyou Nurse Practitioner 168 N Brent St, Suite 502, Ventura, CA 93003-2817 2012-11-15
Find all providers in the same location

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1124645924 Community Memorial Health System Pharmacy 2790 Loma Vista Road, Ventura, CA 93003 2020-06-29
1730702952 Sarah Manon Begert Student in an Organized Health Care Education/Training Program 300 Hillmont Ave., Bldg 340, Ste 201, Ventura, CA 93003 2020-05-21
1033763677 Ashley Danielle Aguilar Counselor 5740 Ralston Suite 100, Ventura, CA 93003 2019-08-01
1730747239 Azadeh Ellsworth Nurse Practitioner 1752 S Victoria Ave Ste 250, Ventura, CA 93003 2019-05-31
1992275556 Melissa Marie Cole Social Worker 4949 Market St, Ventura, CA 93003 2018-11-27
1851868400 Weldon Acupuncture Professional Corporation Acupuncturist 3737 Telegraph Road, Suite F, Ventura, CA 93003 2018-10-31
1952876468 Isabella Florencia Gallegos Specialist/Technologist 1857 Knoll Dr., Ventura, CA 93003 2018-10-11
1437645421 Jill Huang Wong Psychologist 3585 Maple St Ste 248, Ventura, CA 93003 2018-07-02
1346735156 Lisa Ngoc Thi Nguyen Student in an Organized Health Care Education/Training Program 147 N. Brent Street, Ventura, CA 93003 2018-06-25
1457845331 Khloe Frank Student in an Organized Health Care Education/Training Program 300 Hillmont Ave, Bldg 340, Suite 201, Ventura, CA 93003 2018-06-14
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Taxonomy Information

Taxonomy Code 2085R0202X
Grouping Allopathic & Osteopathic Physicians
Classification Radiology
Specialization Diagnostic Radiology

Taxonomy Definition

A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source]
- Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification
- Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1710339833 Stockdale Radiology Physician Services, Inc Radiology 875 Weber Cir, # 201, Ventura, CA 93003-8252 2016-07-13
1538547088 Quantum Medical Radiology of California, PC Radiology 1990 Sunset Dr, Ventura, CA 93001-2355 2015-05-15
1619313566 Roger Goldman Radiology 6250 Telegraph Rd Apt 1310, Ventura, CA 93003 2013-05-20
1306098751 Bahn Consulting Medical Group, Inc. Radiology 168 N Brent St, Suite 402, Ventura, CA 93003 2008-10-16
1134283344 Bruce Matthews Radiology 3291 Loma Vista Rd, Ventura, CA 93003-3099 2006-12-21
1104980317 John Mcmahan Radiology 3291 Loma Vista Rd, Ventura, CA 93003-3099 2006-12-21
1336202365 Matthew Carr Radiology 3291 Loma Vista Rd, Ventura, CA 93003-3099 2006-12-19
1558420398 Reed M. Horwitz Radiology 3291 Loma Vista Rd, Department of Radiology Vcmc, Ventura, CA 93003-3099 2006-12-07
1104916253 Kristina L Jong Radiology 168 N Brent St, Suite 401, Ventura, CA 93003-2817 2006-10-12
1316986938 Kyu Choi Radiology 147 N Brent St, Radiology Department, Ventura, CA 93003-2809 2006-06-06
Find all providers in VENTURA

Competitor

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City VENTURA
Zip Code 93003

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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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