Nivedita Wallace Medical Corporation

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

A75615 Issued in CA

Legal business name

NIVEDITA WALLACE MEDICAL CORPORATION

Practice address

1600 N Rose Ave
Oxnard, CA 93030-3722

Phone

(805) 988-2500

NPI assigned

Jul 14, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Nivedita S. Wallace, M.D.NPI 1306866520

Title

President

Phone

(310) 440-3131

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Nivedita S. Wallace, M.D.

  • Anesthesiology Physician
  • Oxnard, CA
  • NPI 1306866520

  CA

  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205798400000",
    "number": "1033135751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11999 SAN VICENTE BLVD",
            "address_2": "STE. 440",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900495131",
            "telephone_number": "310-440-3131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 N ROSE AVE",
            "city": "OXNARD",
            "state": "CA",
            "postal_code": "930303722",
            "telephone_number": "805-988-2500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NIVEDITA WALLACE MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-14",
        "last_updated": "2008-03-18",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "NIVEDITA",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-440-3131",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": "A75615",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A756150",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nima Michael Nikravesh, DDS
• Rajendra P Niraula, MD
• Maria Niswonger
• Chantal Mayomi Nitowski
• Steven L. Nitsche, RPH
• Rachel Wambui Njenga
• Julissa B Noble, CAODC-A-CS,LAADC-CA
• Behzad Noorbehesht, M.D.
• Rebecca Anne Nordby, LCSW
• Duanning Nordstrom

• All providers in Oxnard, CA
• Anesthesiology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.