institution
Lydia V. Wallace, D.o., P.a.
Community Health Clinic/Center in Hollywood, Florida
NPI 1861766941

Lydia V. Wallace, D.o., P.a. is a Community Health Clinic/Center based in Hollywood, FL and is specialized in Community Health. Lydia V. Wallace, D.o., P.a. practices in Hollywood, FL. The NPI Number for Lydia V. Wallace, D.o., P.a. is 1861766941 and holds a License No. OS 10688 (Florida).

The current practice location address for Lydia V. Wallace, D.o., P.a. is 3021 N 66Th Ave, Hollywood, FL and can be reached out via phone at 754-281-8202.

Location: 3021 N 66Th Ave, Hollywood, FL, 33024-2925
institution
Provider Profile Details
NPI Number
1861766941
Provider Name
Lydia V. Wallace, D.o., P.a.
Credential
Provider Entity Type
Organization
Address
3021 N 66Th Ave, Hollywood, FL, 33024-2925
Phone Number
754-281-8202
Fax Number
Provider Enumeration Date
03/07/2012
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
352349931 05 FL
institution
Provider Business Practice Location Address Details
Address
3021 N 66Th Ave
City
State
Zip
33024-2925
Phone Number
754-281-8202
Fax Number
person
Provider Business Mailing Address Details
Address
3021 N 66Th Ave
City
State
Zip
33024-2925
Phone Number
754-281-8202
Fax Number
person
Provider's Taxonomy Details 1
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Community Health
Taxonomy
License No.
OS 10688 (Florida)
Definition
Definition to come...
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