Organization · Type 2 NPI
Lydia V. Wallace, D.o., P.a.
Community Health Clinic/Center · Hollywood, FL
NPI number
1861766941
Active
Practice location
3021 N 66th Ave
Hollywood, FL 33024-2925
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Community Health Clinic/Center Primary | 261QC1500X | OS 10688 (FL) |
Community Health Clinic/Center: Definition to come...
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About NPI 1861766941
Lydia V. Wallace, D.o., P.a.'s National Provider Identifier is 1861766941, issued on Mar 7, 2012. The primary taxonomy on file is Community Health Clinic/Center (261QC1500X), and the practice location is in Hollywood, FL. The record was last updated on Mar 7, 2012.