Dr. Wallace Llera
Family Doctor - Adult Medicine
401-55 W Allegheny Ave
Philadelphia
, Pennsylvania 19133-3644
Dr. Wallace Llera
Family Doctor - Adult Medicine
401-55 W Allegheny Ave
Philadelphia
, Pennsylvania 19133-3644
(215) 232-4093
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About
Features
Specialties
- Family Doctor - Adult Medicine
Languages spoken
- English
Location
First Address
- Dr. Wallace Llera
- 1412 Fairmount Ave
- Philadelphia, PA
- Zip : 19130-2908
- Fax : (215) 232-4093
- Phone : (215) 599-4851
Second Address
- Dr. Wallace Llera
- 401-55 W Allegheny Ave
- Philadelphia, PA
- Zip : 19133-3644
- Fax : (215) 291-2587
- Phone : (215) 291-2500
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207QA0505X | Family Doctor - Adult Medicine | MD038236L | PA |
National Provider Identifier
| NPI | 1013990332 |
|---|---|
| Provider Name | Dr. Wallace Llera |
| First Address | Philadelphia, PA 19130-2908 |
| Second Address | Philadelphia, PA 19133-3644 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 21/11/2005 |
| Last Update Date | 07/06/2011 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 001019428 - 0022 | (05) | PA |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.