Active NPI
Jennifer Marie Wallace, L.A.C
- Acupuncturist
- Redondo Beach, CA
National Provider Identifier
1124579602
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acupuncturist
- License
- 17329
- Practice address
- 237 Avenida del Norte
Redondo Beach, CA 90277-5702 - Phone
- (310) 483-4957
- NPI assigned
- Oct 19, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acupuncturist | 171100000X | 17329 | CA | Primary |
Addresses
Primary practice location
237 Avenida del Norte
Redondo Beach, CA 90277-5702
Mailing address
237 Avenida del Norte
Redondo Beach, CA 90277-5702
Phone (310) 483-4957
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17329 | CA | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1476835200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1482364800000",
"number": "1124579602",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "237 AVENIDA DEL NORTE",
"city": "REDONDO BEACH",
"state": "CA",
"postal_code": "902775702",
"telephone_number": "310-483-4957"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "237 AVENIDA DEL NORTE",
"city": "REDONDO BEACH",
"state": "CA",
"postal_code": "902775702",
"telephone_number": "310-483-4957"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "JENNIFER",
"middle_name": "MARIE",
"name_prefix": "Miss",
"credential": "L.A.C",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-10-19",
"last_updated": "2016-12-22",
"status": "A"
},
"taxonomies": [
{
"code": "171100000X",
"taxonomy_group": "",
"desc": "Acupuncturist",
"state": "CA",
"license": "17329",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Redondo Beach, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.