Sylvester Lee Wallace Jr.

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

License

NONE

Practice address

21935 Van Buren St Ste A1
Grand Terrace, CA 92313-5652

Phone

(909) 906-1023

Fax

(909) 906-1032

NPI assigned

Dec 28, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

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.

• The Heart Matters Foster Family Agency

  • Foster Care Agency
  • Grand Terrace, CA
  • NPI 1083365910
  NPD
• The Heart Matters Foster Family Agency

  • Foster Care Agency
  • Grand Terrace, CA
  • NPI 1265086094
  NPD

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

{
    "created_epoch": "1703721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708560000000",
    "number": "1427827625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21935 VAN BUREN ST # B13",
            "city": "GRAND TERRACE",
            "state": "CA",
            "postal_code": "923135652",
            "telephone_number": "951-229-1080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21935 VAN BUREN ST STE A1",
            "city": "GRAND TERRACE",
            "state": "CA",
            "postal_code": "923135652",
            "telephone_number": "909-906-1023",
            "fax_number": "909-906-1032"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "SYLVESTER",
        "middle_name": "LEE",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-12-28",
        "last_updated": "2024-02-22",
        "certification_date": "2024-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": null,
            "license": "NONE",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Urcare LLC
• Alejandra Maria Valz-Brenta
• Hanna Vu
• Walgreen Co
• Krista Walker
• Graciela Raya Wangsnes
• James Edward White, FNP
• Wholeness Empowerment Group Licensed Clinical Social Worker, Inc
• Priscilla Anne Willmott
• Dontel D. Wise

• Community Health Worker in Grand Terrace, CA
• Providers in Grand Terrace, CA by specialty
• Community Health Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2024; 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.