ANDREA SHANWTRAE WALLACE (NPI# 1154976777) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154976777 |
| Entity Type | Individual |
| Full Name | ANDREA SHANWTRAE WALLACE |
| Practice Address |
2130 N Arrowhead Ave Ste 205b-1c San Bernardino CA 92405-4029 |
| Practice Telephone | 6615246038 |
| Mailing Telephone | 6615246038 |
| Enumeration Date | 2019-08-09 |
| Last Update Date | 2019-08-09 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 171WV0202X |
Contractor Specialization: Vehicle Modifications |
D6516086 | CA | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | 90934505A95133 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1737 E G St Apt 39, Ontario, CA 917645428 | 6619415028 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871608604 | Andrea L Wallace | Dentist | 2003 S Plaza Rd, Emmett, ID 83617-9180 | 2006-08-20 |
| 1083264485 | Andrea Namon Wallace | Student in an Organized Health Care Education/Training Program | 9808 Venice Blvd Ste 700, Culver City, CA 90232-6824 | 2019-09-17 |
| 1417455809 | Andrea Wallace | Nurse Practitioner | 7810 Providence Rd, Ste 102, Charlotte, NC 28226-2954 | 2018-01-31 |
| 1902116122 | Andrea Wallace | Physical Therapist | 1231 Pine Grove Ave, Suite 1a, Port Huron, MI 48060-3500 | 2010-10-21 |
| 1326166315 | Andrea Yvonne Wallace | Physical Therapy Assistant | 3 Merit Dr, Richmond Heights, OH 44143-1457 | 2007-03-27 |
| 1396819884 | Andrea Lynn Wallace | Audiologist | 7373 West Ln, Stockton, CA 95210-3377 | 2006-11-17 |
| 1669491171 | Andrea S Wallace | Internal Medicine | 101 Manning Dr, Chapel Hill, NC 27599-0001 | 2006-07-18 |
| Street Address |
2130 N ARROWHEAD AVE STE 205B-1C |
| City | SAN BERNARDINO |
| State | CA |
| Zip Code | 92405-4029 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174177497 | New Hope Transitional Living | Clinical Nurse Specialist | 1228 West 31st, San Bernardino, CA 92405 | 2019-07-25 |
| 1336647494 | Paul J Iorio | Counselor | 1669 Norht E Street, San Bernardino, CA 92405 | 2018-01-24 |
| 1609385756 | Abraham Isacc Gonzalez | Registered Nurse | 255 W 17th St, San Bernardino, CA 92405 | 2017-09-20 |
| 1962945675 | Ann Marie Monica Clark | Assisted Living Facility | 3524 Acacia Avenue, San Bernardino, CA 92405 | 2016-11-29 |
| 1801265715 | Leslie Del Toro | Counselor | 2025 N D St, San Bernardino, CA 92405 | 2015-09-21 |
| 1558797324 | Nora Escobar-mandujano | Marriage & Family Therapist | 1441 North 'd' Street, San Bernardino, CA 92405 | 2013-09-24 |
| 1295088284 | Elizabeth Rocha | Counselor | 1669 North E Street, San Bernardino, CA 92405 | 2012-10-16 |
| 1972855237 | Vanessa Kelly Gutierrez | Marriage & Family Therapist | 1669 N E Street, San Bernardino, CA 92405 | 2012-10-11 |
| 1952664021 | Mosley Counseling Center, LLC | Counselor | 2130 W. Arrowhead Ave., Suite 103c, San Bernardino, CA 92405 | 2012-06-22 |
| 1508167602 | Al Shifa Clinic Incorporated | Voluntary or Charitable | 2334 North Sierra Way, San Bernardino, CA 92405 | 2010-11-06 |
| Find all providers in zip 92405 | ||||
| Taxonomy Code | 171WV0202X |
| Grouping | Other Service Providers |
| Classification | Contractor |
| Specialization | Vehicle Modifications |
| A contractor who makes modifications to private vehicles to accommodate a health condition. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972129658 | Clifford R Villaflor Sr. | Contractor | 18800 Amar Rd Ste B16, Walnut, CA 91789-7101 | 2020-06-18 |
| 1306483193 | Charlemagne Previlon | Contractor | 4323 Carmelo Oaks Ct, Sacramento, CA 95841-3474 | 2019-11-29 |
| 1285291161 | Samvel Abramov | Contractor | 6470 Foothill Blvd # J, Tujunga, CA 91042-2729 | 2019-05-25 |
| 1093267122 | Ericson Araullo | Contractor | 9372 Meridian Ln, Garden Grove, CA 92841-1260 | 2016-10-24 |
| 1437508389 | Anna Gavin | Contractor | 1256 W. Lathrop Rd #376, Manteca, CA 95336 | 2016-06-10 |
| 1619334976 | Eyad Totah | Contractor | 15583 Budge St, San Leandro, CA 94579-2305 | 2016-01-18 |
| 1326411356 | U2mobility, Inc. | Contractor | 850 E. Parkridge Ave, #107, Corona, CA 92879-6613 | 2015-11-13 |
| 1063955599 | Fiorella Yong | Contractor | 601 E 7th St, Hanford, CA 93230-4665 | 2016-12-01 |
| 1215246806 | Dennis Lloyd Brewer | Contractor | 1281 Andersen Dr Ste F, San Rafael, CA 94901-5335 | 2010-09-29 |
| City | SAN BERNARDINO |
| Zip Code | 92405 |
Please comment or provide details below to improve the information on ANDREA SHANWTRAE WALLACE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.