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MRS. DEBRA ANN WALLACE FNP
NPI 1770006538
Surgery - Plastic and Reconstructive Surgery in Los Angeles, CA

Active since July 24, 2017
1100 N STATE STREET, CLINIC TOWER A6A231A, LOS ANGELES, CA 90033(323) 409-7788(323) 441-7298 Get Directions Write a Review

NPPES record last updated: June 16, 2018. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jun 16, 2018, Jul 24, 2017 (2 updates tracked since 2017).

About Mrs. Debra Ann Wallace Fnp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MRS. DEBRA ANN WALLACE FNP (NPI 1770006538) is an individual plastic and reconstructive surgery provider in Los Angeles, California, licensed in California (8326) and active in the NPI registry since July 2017.

NPPES Registry Identity

NPI1770006538
Entity TypeIndividualFemale
Primary Taxonomy2086S0122X
Provider Legal NameMRS. DEBRA ANN WALLACECredential: FNP
Location Address1100 N STATE STREET, CLINIC TOWER A6A231ALos Angeles, CA 90033
Mailing Address4632 E Village RdLong Beach, CA 90808-1545 · (323) 409-7788 · Fax (323) 441-7298
Phone(323) 409-7788
Fax(323) 441-7298
Sole ProprietorYes
Enumeration DateJuly 24, 2017
Last NPPES UpdateJune 16, 20182 updates tracked since enumeration
✔ NPI 1770006538 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySurgery · Plastic and Reconstructive SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code2086S0122X
License✔ Licensed in CA · 8326
Definition
A surgeon who specializes in plastic and reconstructive surgery.
1100 N STATE STREET, Los Angeles, CA 90033
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JANE S. KIM RN
Registered Nurse (Ambulatory Care)
1100 N STATE STREET, CT A4A
LOS ANGELES, CA 90033
Los Angeles County (323) 409-5442
USC CARE MEDICAL GROUP, INC.
Clinic/Center (Urgent Care)
1100 N STATE STREET, A1D
LOS ANGELES, CA 90033
Los Angeles County (323) 442-6018
MARIA ISABEL GONZAGA MD
Obstetrics & Gynecology
1100 N STATE STREET, CT-A-7-D
LOS ANGELES, CA 90033
Los Angeles County (323) 409-6931

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Debra Wallace's NPI number?

The NPI number for Debra Wallace is 1770006538. It was assigned to this individual provider in the NPPES registry on July 24, 2017.

Where is Debra Wallace located?

Debra Wallace practices at 1100 N State Street Clinic Tower A6a231a, Los Angeles, CA 90033. The listed phone number is (323) 409-7788.

What is Debra Wallace's specialty?

The primary specialty registered for this NPI is Surgery, specializing in Plastic and Reconstructive Surgery, with taxonomy code 2086S0122X.

When was this NPI record last updated?

The NPPES record for Debra Wallace was last updated on June 16, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.