Llera, Wallace

Llera, Wallace is an individual health care provider with primary practice located at 401-55 W Allegheny Ave , Philadelphia PA 19133-3644. He recently has only one registered license in Allopathic & Osteopathic Physicians / Adult Medicine, which is considered as his primary health care specialty. Llera, Wallace can be contacted via phone (215) 291-2500.

Contact Information

Primary practice address
401-55 W Allegheny Ave Philadelphia PA 19133-3644
Phone: (215) 291-2500
Fax: (215) 291-2587
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Adult Medicine 207QA0505X MD038236L Pennsylvania

Profile Details

NPI number 1013990332
LBN Legal business name Llera, Wallace
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 21st, 2005
Last updated Jun 7th, 2011 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1013990332 NPPES
Pennsylvania MEDICAID 001019428 - 0022

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