Sandra Louise Wallace, MD

Primary specialty

Infectious Disease PhysicianTaxonomy code 207RI0200X

License

G403910 Issued in CA

Practice address

50 Alessandro PL
Suite 360
Pasadena, CA 91105-3149

Phone

(626) 793-6133

Fax

(626) 793-6135

NPI assigned

Aug 10, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1297036800000",
    "number": "1235140930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1449",
            "city": "BREA",
            "state": "CA",
            "postal_code": "928221449",
            "telephone_number": "714-996-1633",
            "fax_number": "714-996-9267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 ALESSANDRO PL",
            "address_2": "SUITE 360",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911053149",
            "telephone_number": "626-793-6133",
            "fax_number": "626-793-6135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "SANDRA",
        "middle_name": "LOUISE",
        "name_prefix": "Ms.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-10",
        "last_updated": "2011-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "CA",
            "license": "G403910",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G403910",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD RETIREMENT",
            "identifier": "110010430",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "00G403910",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anita Wallace
• Cherrish Wallace
• Jason Wallace
• Kendrick Wallace, B.A.
• Rebecca Wallace
• Shanae L Wallace, BI
• Thomas Clyde Wallace, M.D.
• Rhonda Suk Waller-Dang, LMFT, ATR
• Walnut Medical Equiptment, Inc.
• Alexander Craig Walsh, M.D.

• Infectious Disease Physician in Pasadena, CA
• Providers in Pasadena, CA by specialty
• Infectious Disease Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.