Provider Demographics
NPI:1780326744
Name:WALLACE & LEE INFUSION CENTER - A MEDICAL CORPORATION
Entity type:Organization
Organization Name:WALLACE & LEE INFUSION CENTER - A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALISA
Authorized Official - Middle Name:
Authorized Official - Last Name:CABRERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-652-2284
Mailing Address - Street 1:PO BOX 18736
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90209-4736
Mailing Address - Country:US
Mailing Address - Phone:310-652-2284
Mailing Address - Fax:310-855-9309
Practice Address - Street 1:8750 WILSHIRE BLVD STE 210
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2703
Practice Address - Country:US
Practice Address - Phone:310-652-0920
Practice Address - Fax:310-360-4812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-11
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty