Lydia V. Wallace, D.O., P.a.

Primary specialty

Community Health Clinic/CenterTaxonomy code 261QC1500X

License

OS 10688 Issued in FL

Legal business name

LYDIA V. WALLACE, D.O., P.A.

Practice address

3021 N 66TH Ave
Hollywood, FL 33024-2925

Phone

(754) 281-8202

NPI assigned

Mar 7, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Lydia Valladares Wallace, D.O.

Title

Owner

Phone

(954) 721-8202

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1331078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1331078400000",
    "number": "1861766941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3021 N 66TH AVE",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330242925",
            "telephone_number": "754-281-8202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3021 N 66TH AVE",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330242925",
            "telephone_number": "754-281-8202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LYDIA V. WALLACE, D.O., P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-07",
        "last_updated": "2012-03-07",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "LYDIA",
        "authorized_official_middle_name": "VALLADARES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "954-721-8202",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "FL",
            "license": "OS 10688",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "352349931",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Community Health Clinic/Center in Hollywood, FL
• Providers in Hollywood, FL by specialty
• Community Health Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2012; 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.