Johnny Wallace Jr.

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Practice address

1411 W 190TH St
Gardena, CA 90248-4324

Phone

(562) 210-6842

NPI assigned

Mar 29, 2022

Last updated

Mar 29, 2022By the provider in NPPES

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)

Not enrolled

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

{
    "created_epoch": "1648512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648512000000",
    "number": "1750021978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1411 W 190TH ST",
            "city": "GARDENA",
            "state": "CA",
            "postal_code": "902484324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1411 W 190TH ST",
            "city": "GARDENA",
            "state": "CA",
            "postal_code": "902484324",
            "telephone_number": "562-210-6842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "JOHNNY",
        "name_suffix": "Jr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-03-29",
        "last_updated": "2022-03-29",
        "certification_date": "2022-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole Elise Waldschmidt, NONE
• Walgreen Co (Walgreens #07175)
• Mattea Walker Sete
• Darlene M Walker, PSY D
• Ellah Wallace, MFTI
• Ashley Cynthia Walldez
• Erin Elizabeth Waller
• Natasha Waller
• Aniece Walsh
• Heather Marie Walsh

• Behavior Analyst in Gardena, CA
• Providers in Gardena, CA by specialty
• Behavior Analyst in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2022; 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.