GEORGE CARLETON WALLACE (NPI# 1851302202) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1851302202 |
| Entity Type | Individual |
| Full Name | GEORGE CARLETON WALLACE |
| Credential | MD |
| Practice Address |
341 Magnolia Ave Suite 101 Corona CA 92879-3330 |
| Practice Telephone | 9517356060 |
| Practice Fax Number | 9517354510 |
| Mailing Telephone | 9517356060 |
| Mailing Fax Number | 9517354510 |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2011-03-30 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207X00000X | Orthopaedic Surgery | A17429 | CA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | BLUE SHIELD | 00A174290 | 01 |
| CA | 00A174290 | 05 | |
| CA | BLUE CROSS | 00A174290 | 01 |
| RR MEDICARE | 200034605 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063559748 | George Marvin Wallace | Dentist | 710 N Elm St, High Point, NC 27262-3918 | 2007-01-31 |
| 1811001696 | George F. Wallace | Podiatrist | 90 Bergen St, Doc 4500, Newark, NJ 07103-2425 | 2006-08-18 |
| Street Address |
341 MAGNOLIA AVE SUITE 101 |
| City | CORONA |
| State | CA |
| Zip Code | 92879-3330 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578532545 | Paul Richard Reiman | Orthopaedic Surgery | 341 Magnolia Ave, Suite 101, Corona, CA 92879-3330 | 2006-03-14 |
| 1699215087 | Takuma Richard Shito | Physical Medicine & Rehabilitation | 341 Magnolia Ave, Suite 103, Corona, CA 92879-3330 | 2017-03-03 |
| 1043670680 | Uc Irvine Health - Corona (urology) | Clinic/Center | 341 Magnolia Ave, Corona, CA 92879-3330 | 2016-02-24 |
| 1639539265 | Uc Irvine Health- Corona (neurology) | Clinic/Center | 341 Magnolia Ave, Corona, CA 92879-3330 | 2016-02-24 |
| 1992165534 | Uc Irvine Health- Corona (obgyn) | Clinic/Center | 341 Magnolia Ave, Corona, CA 92879-3330 | 2016-02-24 |
| 1033579743 | Uc Irvine Health- Corona (emergency Medicine) | Clinic/Center | 341 Magnolia Ave, Corona, CA 92879-3330 | 2016-02-24 |
| 1912362104 | Kaylee Smith | Physical Therapist | 341 Magnolia Ave, Suite 101, Corona, CA 92879-3330 | 2015-12-15 |
| 1124496773 | Uc Irvine Health - Corona (medicine) | Clinic/Center | 341 Magnolia Ave, Suite 205, Corona, CA 92879-3330 | 2015-09-11 |
| 1467837716 | Andrew W. Shaw | Physician Assistant | 341 Magnolia Ave, Suite 101, Corona, CA 92879-3330 | 2015-07-28 |
| 1508283664 | Ralph Gozun | Physical Therapist | 341 Magnolia Ave, Suite 101, Corona, CA 92879-3330 | 2014-03-26 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609475722 | Tahmea Henderson | Behavior Technician | 225 Rincon St. #219, Corona, CA 92879 | 2020-10-20 |
| 1669084828 | Kimberly O Harris | Behavioral Analyst | 225 E. Rincon St., Suite 219, Corona, CA 92879 | 2020-08-19 |
| 1962014381 | Mario Javier Herrera | Nurse Practitioner | 2130 High Pointe Dr, Apt 108, Corona, CA 92879 | 2020-08-18 |
| 1841659117 | Sleep & Cpap Center Inc | Clinical Medical Laboratory | 800 Magnolia Avenue, Suite 101, Corona, CA 92879 | 2016-02-16 |
| 1497151203 | Rafik Riad | Dentist | 817 Villa Montes Cir., Corona, CA 92879 | 2014-11-06 |
| 1326441551 | Ying Zhang Howe | Acupuncturist | 720 Magnolia Ave. #b3, Corona, CA 92879 | 2014-10-02 |
| 1164823233 | Piyush Sakhareliya | Pharmacist | 2230 Treemont Pl, Apt#207, Corona, CA 92879 | 2014-09-09 |
| 1053711739 | Brandice Medical Associates Inc | Clinical Medical Laboratory | 13575 Jasper Loop, Corona, CA 92879 | 2014-08-29 |
| 1982956058 | Nja Therapy Services, Inc. | Day Training, Developmentally Disabled Services | 1655 E 6th St Suite 204, Corona, CA 92879 | 2012-10-12 |
| 1356616064 | Corona Surgical LLC | Clinic/Center | 2370 Anselmo Drive, Corona, CA 92879 | 2012-03-13 |
| Find all providers in zip 92879 | ||||
| Taxonomy Code | 207X00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| An orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated structures by medical, surgical and physical means. An orthopaedic surgeon is involved with the care of patients whose musculoskeletal problems include congenital deformities, trauma, infections, tumors, metabolic disturbances of the musculoskeletal system, deformities, injuries and degenerative diseases of the spine, hands, feet, knee, hip, shoulder and elbow in children and adults. An orthopaedic surgeon is also concerned with primary and secondary muscular problems and the effects of central or peripheral nervous system lesions of the musculoskeletal system. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. American Osteopathic Board of Orthopaedic Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Orthopaedic Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Orthopaedic Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770851339 | Robert Leland Horner Sr. | Orthopaedic Surgery | 3981 Holly Springs Dr, Corona, CA 92881-8215 | 2011-12-09 |
| 1598872657 | Corona Orthopaedic Associates Medical Group Incorporated | Orthopaedic Surgery | 341 Magnolia Avenue, Suite 101, Corona, CA 92879-3331 | 2006-08-24 |
| 1164483699 | Vicente R Bernabe | Orthopaedic Surgery | 1191 Magnolia Ave, Ste D-152, Corona, CA 92879-3215 | 2006-04-02 |
| 1578532545 | Paul Richard Reiman | Orthopaedic Surgery | 341 Magnolia Ave, Suite 101, Corona, CA 92879-3330 | 2006-03-14 |
| 1124025598 | Michael T. Mai | Orthopaedic Surgery | 21634 Retreat Pkwy, Corona, CA 92883-6100 | 2005-06-30 |
| 1730523945 | Nasser Heyrani | Orthopaedic Surgery | 341 Magnolia Ave Ste 101, Corona, CA 92879-3331 | 2013-04-18 |
| 1386941219 | Reza Roghani | Orthopaedic Surgery | 341 Magnolia Ave Ste 101, Corona, CA 92879-3331 | 2011-02-10 |
| 1467520189 | John Stephen Locke | Orthopaedic Surgery | 341 Magnolia Ave, Ste 101, Corona, CA 92879-3330 | 2006-12-01 |
| 1295837342 | Richard Leino Rouhe | Orthopaedic Surgery | 341 Magnolia Ave, Suite 101, Corona, CA 92879-3330 | 2006-09-01 |
| 1629089073 | Ghassan Said Tooma | Orthopaedic Surgery | 341 Magnolia Ave, Ste 101, Corona, CA 92879-3331 | 2006-08-11 |
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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.