David Wallace, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA59863 Issued in CA

Practice address

18350 Roscoe Blvd # 702
Northridge, CA 91325-4109

Phone

(818) 280-5961

Fax

(818) 280-5983

NPI assigned

Jul 30, 2021

Sex

Male

Sole proprietor

No

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

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

United Medical DoctorsGroup PAC ID 2961305651, 168 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/9170/brand/1/csg/1/fhir/r4

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.

• United Medical Doctors

  • Gastroenterology Physician
  • Murrieta, CA
  • NPI 1770559981
  Medicare reassignment Care Compare group
• United Medical Doctors

  • Orthopaedic Surgery Physician
  • San Diego, CA
  • NPI 1194554675
  NPD

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

{
    "created_epoch": "1627603200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756339200000",
    "number": "1730852179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18350 ROSCOE BLVD # 702",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913254109",
            "telephone_number": "818-280-5961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18350 ROSCOE BLVD # 702",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913254109",
            "telephone_number": "818-280-5961",
            "fax_number": "818-280-5983"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5555 Inglewood Blvd",
            "address_purpose": "LOCATION",
            "city": "Culver City",
            "state": "CA",
            "postal_code": "902306226",
            "country_code": "US",
            "telephone_number": "424-532-1552",
            "fax_number": "888-247-7249",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "DAVID",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-07-30",
        "last_updated": "2025-08-28",
        "certification_date": "2025-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA59863",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fatima Wahab
• Walgreen Co
• Walid S Arnaout MD a Medical Corporation
• Christian Walker
• Randy Walker
• David Carter Wallace, DO
• Walmart, Inc.
• Walter E. Jacobson, MD, Inc.
• Debbie Wang, D.O.
• Jeffrey Chinwei Wang, D.O.

• Physician Assistant in Northridge, CA
• Providers in Northridge, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.