Wallace Llera M.D.

NPI 1013990332 - Family Medicine - 207QA0505X

NPI Details
NPI 1013990332
Gender Male
Enumeration Date 11/21/2005
Last Updated 06/07/2011
Entity Type Individual
Active Over 11 years ago
Practice Location
401-55 W ALLEGHENY AVE
PHILADELPHIA PA, 19133-3644, US
Phone (215) 291-2500
Fax (215) 291-2587
Business Location
1412 FAIRMOUNT AVE
PHILADELPHIA PA, 19130-2908, US
Phone (215) 599-4851
Fax (215) 232-4093
Toxanomy
Taxonomy Code 207QA0505X
License State Pennsylvania
License Number MD038236L
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According to our database, Dr. Wallace Llera M.D. NPI is 1013990332, taxonomy code is 207QA0505X and license number is MD038236L, license state is located at Pennsylvania. Wallace Llera M.D. physically located at 401-55 W Allegheny Ave, Philadelphia PA, 19133-3644. NPI Number Wallace Llera M.D. has the Individual type.

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1013990332 NPI number is provided on an as is basis without warranty of any kind. 1013990332 is maintained by the National Plan & Provider Enumeration System. The contents of Wallace Llera M.D. are for informational purposes only.