JOHN GEORGE WALLACE JR. (NPI# 1164467320) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164467320 |
| Entity Type | Individual |
| Full Name | JOHN GEORGE WALLACE JR. |
| Credential | M.D. |
| Practice Address |
4101 Torrance Blvd Em Dept Torrance CA 90503-4607 |
| Mailing Address |
4401 W Memorial Rd Suite 121 Oklahoma City OK 73134-1785 |
| Practice Telephone | 3105407676 |
| Practice Fax Number | 4057513183 |
| Mailing Telephone | 4057514664 |
| Mailing Fax Number | 4057513183 |
| Enumeration Date | 2006-06-19 |
| Last Update Date | 2012-09-19 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207PE0004X |
Emergency Medicine Specialization: Emergency Medical Services |
G45690 | CA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | 00G456900 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023508868 | John E Wallace | Physical Therapist | 1060 Nimitzview Dr Ste 205, Cincinnati, OH 45230-4351 | 2018-05-17 |
| 1679900161 | John D Wallace | Counselor | 1455 Nw 53rd St Apt 222, Miami, FL 33142 | 2013-09-30 |
| 1437590973 | John Burton Wallace V | Social Worker | 141 S 5th St Ofc East, Brooklyn, NY 11211 | 2013-07-12 |
| 1346517307 | John Widtsoe Wallace | Specialist | 1091 Southport Dr, Medina, OH 44256-3019 | 2011-11-18 |
| 1225292634 | John Wallace | Anesthesiology | 3420 S Mercy Rd Ste 200, Gilbert, AZ 85297-0423 | 2008-07-15 |
| 1629241070 | John Dean Wallace Jr. | Dentist | 9913 Mission Gorge Rd Unit 1, Santee, CA 92071-3843 | 2008-04-08 |
| 1275663916 | John Robert Wallace | Physical Therapist | 103 W Woodhill Dr, Suite A, Nags Head, NC 27959 | 2007-03-06 |
| 1346379161 | John G Wallace | Psychiatry & Neurology | 17515 N Park Pl N, Shoreline, WA 98133-4803 | 2007-03-05 |
| 1841359775 | John Thomas Wallace | Chiropractor | 3314 Us Highway 431, Albertville, AL 35950 | 2006-12-06 |
| 1316038839 | John Kline Wallace | Dentist | 2501 Princess Anne St, Fredericksburg, VA 22401-3333 | 2006-09-28 |
| Street Address |
4101 TORRANCE BLVD EM DEPT |
| City | TORRANCE |
| State | CA |
| Zip Code | 90503-4607 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437142312 | Little Co Pharmacy | Pharmacy | 4101 Torrance Blvd, Torrance, CA 90503-4607 | 2005-08-25 |
| 1265044143 | Vanessa Escobar | Student in an Organized Health Care Education/Training Program | 4101 Torrance Blvd, Torrance, CA 90503-4607 | 2020-08-20 |
| 1538782149 | Sabrina Rae Verzosa Co | Pharmacist | 4101 Torrance Blvd, Torrance, CA 90503-4607 | 2020-05-19 |
| 1689210718 | Daniel Abanoub Keroles | Pharmacist | 4101 Torrance Blvd, Torrance, CA 90503-4607 | 2019-11-25 |
| 1134761091 | Zahra Esmail D O Professional Corp | Internal Medicine | 4101 Torrance Blvd, Torrance, CA 90503-4607 | 2019-10-11 |
| 1598312498 | Jonathan Malcolm Rojas | Nurse Practitioner | 4101 Torrance Blvd, Torrance, CA 90503-4607 | 2019-08-25 |
| 1497308936 | Katelyn Hicks | Nurse Practitioner | 4101 Torrance Blvd, Torrance, CA 90503-4607 | 2019-07-23 |
| 1780140780 | Shahida P Meghani | Nurse Practitioner | 4101 Torrance Blvd, Torrance, CA 90503-4607 | 2019-02-14 |
| 1609358977 | Providence Medical Institute | Hospitalist | 4101 Torrance Blvd, Torrance, CA 90503-4607 | 2018-09-04 |
| 1750869566 | Providence Little Company of Mary, Torrance | General Acute Care Hospital | 4101 Torrance Blvd, Torrance, CA 90503-4607 | 2018-08-02 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013562180 | Jason Anthony Maglinao | Chiropractor | 21010 Anza Ave., #12, Torrance, CA 90503 | 2019-08-06 |
| 1891288890 | Ehab Samaan Dds Inc | Dentist | 19019 Hawthorne Blvd Ste 100b, Torrance, CA 90503 | 2018-06-13 |
| 1740771435 | Icare California House Call Practice LLC | Nurse Practitioner | 4460 Spencer St, Torrance, CA 90503 | 2018-05-29 |
| 1396258729 | South Bay Home Care, Inc., Dba Always Best Care - South Bay | In Home Supportive Care | 370 S. Crenshaw Blvd., Ste. E106, Torrance, CA 90503 | 2017-11-07 |
| 1770093023 | Home Care Professional Services, Inc. | In Home Supportive Care | 3838 West Carson Street, Suite 208, Torrance, CA 90503 | 2017-10-01 |
| 1003355686 | Mona Nejad | Dentist | 4305 Torrance Blvd Ste 103, Torrance, CA 90503 | 2017-02-16 |
| 1497114722 | Jacqueline Martinez | Technician, Other | 4201 Torrance Blvd Suite 190, Torrance, CA 90503 | 2016-02-15 |
| 1093196255 | Hanmo Gu | Chiropractor | 3510 Torrance Blvd., Ste 106, Torrance, CA 90503 | 2015-06-13 |
| 1164813341 | Aimee Y Miyazawa | Specialist/Technologist | 20501 Earl St. Ste. 3, Torrance, CA 90503 | 2015-02-10 |
| 1396145231 | Nicole Soghomonian | Social Worker | 5010 Merrill St, Torrance, CA 90503 | 2014-08-28 |
| Find all providers in zip 90503 | ||||
| Taxonomy Code | 207PE0004X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| Specialization | Emergency Medical Services |
| An emergency medicine physician who specializes in non-hospital based emergency medical services (e.g., disaster site, accident scene, transport vehicle, etc.) to provide pre-hospital assessment, treatment, and transport patients. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A Certification of Added Qualifications (CAQ) is issued by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114982782 | Joseph F Lopez | Emergency Medicine | 3475 Torrance Blvd Ste D, Torrance, CA 90503-5800 | 2006-04-18 |
| 1518525153 | Angela Yang Shvartsman | Emergency Medicine | 3330 Lomita Blvd, Torrance, CA 90505-5002 | 2019-05-30 |
| 1003145046 | Torrance Emergency Care Associates, Inc. | Emergency Medicine | 3105 Lomita Blvd, Torrance, CA 90505-5108 | 2009-12-22 |
| 1386814671 | Christopher Jason Angemi | Emergency Medicine | 1000 W Carson St, Emergency Medicine Dept Box 21, Torrance, CA 90509 | 2008-03-03 |
| 1073558235 | Jorge Thomas Vournas | Emergency Medicine | 4101 Torrance Blvd, Em Dept, Torrance, CA 90503-4607 | 2006-06-19 |
| 1952346124 | David Esaul Munoz | Emergency Medicine | 4101 Torrance Blvd, Em Dept, Torrance, CA 90503-4607 | 2006-06-19 |
| 1770528945 | David Michael Scherer | Emergency Medicine | 4101 Torrance Blvd, Em Dept, Torrance, CA 90503-4607 | 2006-06-19 |
| 1609811876 | Marc Richard Cohen | Emergency Medicine | 4101 Torrance Blvd, Em Dept, Torrance, CA 90503-4607 | 2006-06-19 |
| 1255373924 | Eugene Bradford Baldridge | Emergency Medicine | 4101 Torrance Blvd, Em Dept, Torrance, CA 90503-4607 | 2006-06-10 |
| 1639111313 | William Adam Conrad | Emergency Medicine | 4101 Torrance Blvd, Em Dept, Torrance, CA 90503-4607 | 2006-06-10 |
| Find all providers in TORRANCE | ||||
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| 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.