JENNIFER KATHERINE WALLACE (NPI# 1578796926) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578796926 |
| Entity Type | Individual |
| Full Name | JENNIFER KATHERINE WALLACE |
| Credential | PA-C |
| Practice Address |
2660 E Main St Suite 204 Ventura CA 93003-2893 |
| Practice Telephone | 8056437500 |
| Practice Fax Number | 8056437501 |
| Mailing Telephone | 8056437500 |
| Mailing Fax Number | 8056437501 |
| Enumeration Date | 2009-09-02 |
| Last Update Date | 2010-09-08 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PA20925 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | CA PHYSICIAN ASSISTANT LICENSE | PA20925 | 01 |
| CO | PHYSICIAN ASSISTANT LICENSE | 2826 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356968440 | Jennifer Wallace | Technician/Technologist | 2041 E 3rd Dr, Mesa, AZ 85204-1401 | 2020-07-06 |
| 1497249882 | Jennifer Laird Wallace | Licensed Practical Nurse | 4468 Duff Rd, Livingston, TX 77351-5627 | 2018-06-19 |
| 1124579602 | Jennifer Marie Wallace | Acupuncturist | 237 Avenida Del Norte, Redondo Beach, CA 90277-5702 | 2016-10-19 |
| 1174926984 | Jennifer Wallace | Specialist/Technologist | 806 Patton Chapel Trl, Hoover, AL 35226-2254 | 2014-10-07 |
| 1295083897 | Jennifer Wallace | Psychologist | 4226 Green Lake Rd, West Bloomfield, MI 48323-1139 | 2012-08-29 |
| 1669799086 | Jennifer Renea Wallace | Counselor | 3802 W University Blvd Apt 8104, Durant, OK 74701-3047 | 2010-04-24 |
| 1306035431 | Jennifer L Wallace | Physical Therapist | 3891 50th Ave S, Saint Petersburg, FL 33711-4811 | 2007-10-15 |
| 1316974058 | Jennifer Wallace | Speech-Language Pathologist | 1901 Century Blvd Ne Ste 20, Atlanta, GA 30345-3300 | 2006-06-27 |
| 1992766570 | Jennifer P Wallace | Specialist | 64400 E 26th Ct, Byers, CO 80103-8539 | 2006-03-31 |
| 1730154154 | Jennifer Lyn Wallace | Family Medicine | 1235 Se Division St, Suite 208, Portland, OR 97202-1099 | 2006-02-20 |
| Street Address |
2660 E MAIN ST SUITE 204 |
| City | VENTURA |
| State | CA |
| Zip Code | 93003-2893 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063441327 | Denise Stennette | Orthopaedic Surgery | 2660 E Main St, Ventura, CA 93003-2893 | 2006-06-30 |
| 1548503501 | Life Springs Hospice Care - Ventura Inc | Hospice Care, Community Based | 2660 E Main St, Suite 203, Ventura, CA 93003-2893 | 2013-03-28 |
| 1225210339 | Alexandre Yves Hillairet | Acupuncturist | 2660 E Main St, Ste 202, Ventura, CA 93003-2893 | 2007-11-30 |
| 1083809560 | Valerie Sussman | Pediatrics | 2660 E Main St, 204, Ventura, CA 93003-2893 | 2007-09-07 |
| 1275564544 | Michael Steinbaum | Podiatrist | 2660 E Main St, Ventura, CA 93003-2893 | 2006-07-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124645924 | Community Memorial Health System | Pharmacy | 2790 Loma Vista Road, Ventura, CA 93003 | 2020-06-29 |
| 1730702952 | Sarah Manon Begert | Student in an Organized Health Care Education/Training Program | 300 Hillmont Ave., Bldg 340, Ste 201, Ventura, CA 93003 | 2020-05-21 |
| 1033763677 | Ashley Danielle Aguilar | Counselor | 5740 Ralston Suite 100, Ventura, CA 93003 | 2019-08-01 |
| 1730747239 | Azadeh Ellsworth | Nurse Practitioner | 1752 S Victoria Ave Ste 250, Ventura, CA 93003 | 2019-05-31 |
| 1992275556 | Melissa Marie Cole | Social Worker | 4949 Market St, Ventura, CA 93003 | 2018-11-27 |
| 1851868400 | Weldon Acupuncture Professional Corporation | Acupuncturist | 3737 Telegraph Road, Suite F, Ventura, CA 93003 | 2018-10-31 |
| 1952876468 | Isabella Florencia Gallegos | Specialist/Technologist | 1857 Knoll Dr., Ventura, CA 93003 | 2018-10-11 |
| 1437645421 | Jill Huang Wong | Psychologist | 3585 Maple St Ste 248, Ventura, CA 93003 | 2018-07-02 |
| 1346735156 | Lisa Ngoc Thi Nguyen | Student in an Organized Health Care Education/Training Program | 147 N. Brent Street, Ventura, CA 93003 | 2018-06-25 |
| 1457845331 | Khloe Frank | Student in an Organized Health Care Education/Training Program | 300 Hillmont Ave, Bldg 340, Suite 201, Ventura, CA 93003 | 2018-06-14 |
| Find all providers in zip 93003 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982890042 | Carla Allison Mull | Physician Assistant | 2660 E Main St Ste 100, Ventura, CA 93003-2893 | 2007-09-21 |
| 1265434385 | Cathryn Diane Ingram | Physician Assistant | 138 W Main St, Suite E, F, G, Ventura, CA 93001-2584 | 2005-06-01 |
| 1457787467 | Vivian Thanh Nguyen | Physician Assistant | 200 S Wells Rd, Ventura, CA 93004-1377 | 2013-09-23 |
| 1174777536 | Elmira Mira Shishim | Physician Assistant | 200 S Wells Rd, Suite 200, Ventura, CA 93004-1377 | 2008-11-12 |
| 1346271277 | Cynthia Coggins | Physician Assistant | 888 S Hill Rd, Ventura, CA 93003-8400 | 2006-07-06 |
| 1659303394 | Jonathan Salire | Physician Assistant | 888 S Hill Rd, Ventura, CA 93003-8400 | 2006-07-06 |
| 1164454807 | James Noud | Physician Assistant | 888 S Hill Rd, Ventura, CA 93003-8400 | 2006-07-06 |
| 1851323596 | Jose Gomez | Physician Assistant | 888 S Hill Rd, Ventura, CA 93003-8400 | 2006-07-06 |
| 1548217292 | Jeanne Gilbert | Physician Assistant | 138 W Main St, Unit E, Ventura, CA 93001-2584 | 2006-05-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760089437 | Karine Harutyunyan | Physician Assistant | 500 E Colorado St Ste 101, Glendale, CA 91205-1607 | 2020-10-06 |
| 1437756228 | Kale Burket | Physician Assistant | Bldg 523, S 8th St, El Centro, CA 92243 | 2020-10-05 |
| 1548867666 | Heba Marzouk Al-shoubaki | Physician Assistant | 633 S Pepper St, Anaheim, CA 92802-1459 | 2020-10-01 |
| 1275140550 | Lisa Lynn Passalacqua | Physician Assistant | 431 7th St, Norco, CA 92860-1671 | 2020-09-30 |
| 1144833989 | Trisha Taylor | Physician Assistant | 10399 Tivoli Way, Yucaipa, CA 92399-6017 | 2020-08-30 |
| 1457963944 | Harlan William Monahan | Physician Assistant | 5210 Del Rio Rd, Sacramento, CA 95822-2519 | 2020-08-18 |
| 1275144313 | Sofia Carmen Bustillo | Physician Assistant | 1709 Coral Pl, Seal Beach, CA 90740-5712 | 2020-08-12 |
| 1124638663 | Gayaneh Gharakhani | Physician Assistant | 1323 E Broadway Apt 110, Glendale, CA 91205-4018 | 2020-08-07 |
| 1144830183 | Loc Bao Tran | Physician Assistant | 8937 Emerson Pl, Rosemead, CA 91770-2813 | 2020-08-04 |
| 1558997957 | Sarah Lubinsky | Physician Assistant | 1511 Montana Ave, Santa Monica, CA 90403-1891 | 2020-03-17 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on JENNIFER KATHERINE 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.