Jefferey Wallace, is a
Student In An Organized Health Care Education/training Program based in Santa Cruz, California. Jefferey Wallace is licensed to practice in * (Not Available) (license number ) and his current practice location is
1400 Emeline Ave Bldg K, Santa Cruz, California. He can be reached at his office (for appointments etc.) via phone at
(831) 345-7746.
NPI number for Jefferey Wallace is 1902023070 and his current mailing address is 125 Blaine St Apt I, Santa Cruz, California. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1902023070.
Healthcare Provider's Profile
| Full Name | Jefferey Wallace |
|---|
| Gender | Male |
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| Speciality | Student In An Organized Health Care Education/training Program |
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| Location | 1400 Emeline Ave Bldg K, Santa Cruz, California |
|---|
| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
|---|
NPI Data:
- NPI Number: 1902023070
- Provider Enumeration Date: 04/19/2007
- Last Update Date: 08/26/2025
Medical Identifiers
Medical identifiers for Jefferey Wallace such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1902023070 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 101Y00000X | Counselor | (* (Not Available)) | Secondary |
| 390200000X | Student In An Organized Health Care Education/training Program | (* (Not Available)) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Jefferey Wallace is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Jefferey Wallace,
125 Blaine St Apt I,
Santa Cruz, CA 95060-2894
Ph: () - | Jefferey Wallace,
1400 Emeline Ave Bldg K,
Santa Cruz, CA 95060-1976
Ph: (831) 345-7746 |
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