David Wallis Medical Corporation

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

DAVID WALLIS MEDICAL CORPORATION

Practice address

520 N Prospect Ave Ste 309
Redondo Beach, CA 90277-3043

Phone

(424) 437-4700

Fax

(424) 437-8884

NPI assigned

Nov 30, 2021

Organization subpart

No

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

Authorized official

Name

David H Wallis, MDNPI 1255383139

Title

Owner

Phone

(424) 437-4700

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA2 enrollments

Enrollment records 2

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• David Wallis, MD

  • Internal Medicine Physician
  • Redondo Beach, CA
  • NPI 1255383139
  Medicare reassignment Care Compare group NPD Authorized official
• Mona Madani, M.D.

  • Family Medicine Physician
  • Redondo Beach, CA
  • NPI 1891112223
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1638230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727395200000",
    "number": "1629736384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 66657",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981660657",
            "telephone_number": "424-437-4700",
            "fax_number": "424-437-8884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 N PROSPECT AVE STE 309",
            "city": "REDONDO BEACH",
            "state": "CA",
            "postal_code": "902773043",
            "telephone_number": "424-437-4700",
            "fax_number": "424-437-8884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVID WALLIS MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-30",
        "last_updated": "2024-09-27",
        "certification_date": "2024-09-27",
        "status": "A",
        "authorized_official_last_name": "WALLIS",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "424-437-4700",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cassandra Darling, PHARMD, RPH
• Phillip E. Darragh, D.P.M.
• Phalisha Monique Dashel Perkins
• Gantuya Davaa
• Brenda Flores Davalos, SLPA 1390
• Joshua Michael Ian Davidson, M.D., M.P.H.
• Sanford Stephen Davidson, MD
• Davis in-Home Care, Inc.
• Aliyah Davis
• Frank Kevin Davis, MS

• Internal Medicine Physician in Redondo Beach, CA
• Providers in Redondo Beach, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.