Jefferey Wallace

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

1400 Emeline Ave BLDG K
Santa Cruz, CA 95060-1976

Phone

(831) 345-7746

NPI assigned

Apr 19, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

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": "1176940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756166400000",
    "number": "1902023070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 BLAINE ST APT I",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950602894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 EMELINE AVE BLDG K",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950601976",
            "telephone_number": "831-345-7746"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6980 Chestnut St",
            "address_purpose": "LOCATION",
            "city": "Gilroy",
            "state": "CA",
            "postal_code": "950206635",
            "country_code": "US",
            "telephone_number": "408-842-7138",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "JEFFEREY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-19",
        "last_updated": "2025-08-26",
        "certification_date": "2025-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Margaret Vivien Walker
• Raelene Walker, M.D.
• Susan Walker
• David M Wall, MPA, PA-C
• Jack Browning Wallace, PHARM. D
• Kieran Wallace
• Susan Lee Wallace, LCSW
• Deborah Waller, OT
• Marissa Catherine Walls
• Babette Wallters, RN

• Student in an Organized Health Care Education/Training Program in Santa Cruz, CA
• Providers in Santa Cruz, CA by specialty
• Student in an Organized Health Care Education/Training Program in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2025; 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.