Active NPI
Qyana Anyese Wallace, A.S.W.
- Social Worker
- Torrance, CA
National Provider Identifier
1235264524
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 20558
- Practice address
- 4025 W 226TH St
Torrance, CA 90505-2340 - Phone
- (310) 373-4556
- Fax
- (310) 375-1784
- NPI assigned
- Feb 23, 2007
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 20558 | CA | Primary |
Addresses
Primary practice location
4025 W 226TH St
Torrance, CA 90505-2340
Mailing address
1262 Flint Dr
Harbor City, CA 90710-3444
Phone (310) 534-4779
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 |
|---|---|---|---|
| 20558 | CA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172188800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1235264524",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1262 FLINT DR",
"city": "HARBOR CITY",
"state": "CA",
"postal_code": "907103444",
"telephone_number": "310-534-4779"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4025 W 226TH ST",
"city": "TORRANCE",
"state": "CA",
"postal_code": "905052340",
"telephone_number": "310-373-4556",
"fax_number": "310-375-1784"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "QYANA",
"middle_name": "ANYESE",
"name_prefix": "Ms.",
"credential": "A.S.W.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-23",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "CA",
"license": "20558",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Torrance, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.