LYDIA V. WALLACE, D.O., P.A. (NPI# 1861766941) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861766941 |
| Entity Type | Organization |
| Organization Name | LYDIA V. WALLACE, D.O., P.A. |
| Practice Address |
3021 N 66th Ave Hollywood FL 33024-2925 |
| Practice Telephone | 7542818202 |
| Mailing Telephone | 7542818202 |
| Enumeration Date | 2012-03-07 |
| Last Update Date | 2012-03-07 |
| Authorized Official Name | DR. LYDIA VALLADARES WALLACE (OWNER) |
| Authorized Official Telephone | 9547218202 |
| Authorized Official Credential | D.O. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QC1500X |
Clinic/Center Specialization: Community Health |
OS 10688 | FL | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 352349931 | 05 |
| Street Address |
3021 N 66TH AVE |
| City | HOLLYWOOD |
| State | FL |
| Zip Code | 33024-2925 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
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| 1992263636 | Cortney D Johnson | Social Worker | 1773 Nw 74th Way, Hollywood, FL 33024 | 2019-03-12 |
| 1760964613 | Family Medical Supplies LLC | Durable Medical Equipment & Medical Supplies | 7777 Davie Rd Ext, Ste 302 A-z, Hollywood, FL 33024 | 2018-09-06 |
| 1639650427 | Delone Elizabeth Plummer | Nurse Practitioner | 3157 N Univesity Dr, Pembroke Pines, FL 33024 | 2018-08-28 |
| 1467943126 | Bl Medical Center, Inc | Dermatology | 9050 Pines Blvd Ste 363, Pembroke Pines, FL 33024 | 2018-05-29 |
| 1952890360 | Rosmery Perez | Behavior Technician | 6610 Meade St, Hollywood, FL 33024 | 2018-05-02 |
| 1447747134 | Joseph P Robert | Technician, Health Information | 8471 Nw19th St, Pembroke Pines, FL 33024 | 2018-04-18 |
| 1164929329 | Yanelis Gutierrez Rodriguez | Behavior Technician | 321 Nw 78t Terrace Apt 104, Apt104 B32, Pembroke Pines, FL 33024 | 2018-04-12 |
| 1134621949 | Llc Tm's Care Enterprise | Clinic/Center | 9113-9117 Taft Street, Pembroke Pines, FL 33024 | 2018-03-07 |
| Find all providers in zip 33024 | ||||
| Taxonomy Code | 261QC1500X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Community Health |
| Definition to come... |
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| 1790868495 | Acr Medical Clinic Inc | Clinic/Center | 6517 Taft St, Suite 207, Hollywood, FL 33024 | 2006-10-24 |
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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.