Active NPI
Anthony Ray Wallace
- Case Management Agency
- East Los Angeles, CA
National Provider Identifier
1851574347
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Management Agency
- Practice address
- 4849 Civic Center Way
East Los Angeles, CA 90022 - Phone
- (323) 780-2125
- NPI assigned
- Dec 7, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Management Agency | 251B00000X | Primary |
Addresses
Primary practice location
4849 Civic Center Way
East Los Angeles, CA 90022
Mailing address
9150 East Imperial Highway
Room P31
Downey, CA 90242
Phone (562) 940-3694
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1196985600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1196985600000",
"number": "1851574347",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9150 EAST IMPERIAL HIGHWAY",
"address_2": "ROOM P31",
"city": "DOWNEY",
"state": "CA",
"postal_code": "90242",
"telephone_number": "562-940-3694",
"fax_number": "562-658-4725"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4849 CIVIC CENTER WAY",
"city": "EAST LOS ANGELES",
"state": "CA",
"postal_code": "90022",
"telephone_number": "323-780-2125"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "ANTHONY",
"middle_name": "RAY",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-12-07",
"last_updated": "2007-12-07",
"status": "A"
},
"taxonomies": [
{
"code": "251B00000X",
"taxonomy_group": "",
"desc": "Case Management",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in East Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.