| Lydia V. Wallace, D.o., P.a. | |
|
3021 N 66th Ave Hollywood FL 33024-2925 | |
| (754) 281-8202 | |
| Not Available |
| Full Name | Lydia V. Wallace, D.o., P.a. |
|---|---|
| Speciality | Clinic/center - Community Health |
| Location | 3021 N 66th Ave, Hollywood, Florida |
| Authorized Official Name and Position | Lydia Valladares Wallace (OWNER) |
| Authorized Official Contact | 9547218202 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lydia V. Wallace, D.o., P.a. 3021 N 66th Ave Hollywood FL 33024-2925 Ph: (754) 281-8202 | Lydia V. Wallace, D.o., P.a. 3021 N 66th Ave Hollywood FL 33024-2925 Ph: (754) 281-8202 |
| NPI Number | 1861766941 |
|---|---|
| Provider Enumeration Date | 03/07/2012 |
| Last Update Date | 03/07/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861766941 | NPI | - | NPPES |
| 352349931 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QC1500X | Clinic/center - Community Health | OS 10688 (Florida) | Primary |
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