Mark S Wallen, DPM

Primary specialty

PodiatristTaxonomy code 213E00000X

License

E3104 Issued in CA

Practice address

2001 Santa Monica Blvd
#1190W
Santa Monica, CA 90404-2102

Phone

(310) 828-0122

Fax

(310) 828-4463

NPI assigned

Feb 21, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Arizona Dermatology Specialists, PLLC

  • Dermatology Physician
  • Surprise, AZ
  • NPI 1992061162
  NPD (past)

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

{
    "created_epoch": "1140480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579564800000",
    "number": "1306811674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1260 15TH ST",
            "address_2": "STE 1014",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904041145",
            "telephone_number": "310-828-0122",
            "fax_number": "310-828-4463"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 SANTA MONICA BLVD",
            "address_2": "#1190W",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904042102",
            "telephone_number": "310-828-0122",
            "fax_number": "310-828-4463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLEN",
        "first_name": "MARK",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-21",
        "last_updated": "2020-01-21",
        "certification_date": "2020-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "CA",
            "license": "E3104",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jackson Wall, APCC, AMFT
• Wendy Wall
• Arla Strassburg Wallace, PH.D.
• Michael J. Wallace, M.D.
• William L Wallace, PHD
• David Wallenstein
• Wendy Walsdorf, LMFT
• Therese Anne Walsh, L.AC., PH.D.
• Walter K Theis MD a Medical Corporation
• Anique Walters, DPT

• Podiatrist in Santa Monica, CA
• Providers in Santa Monica, CA by specialty
• Podiatrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.