Basic Information
| Provider Information | |||||||||
| NPI: | 1215033295 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WALLIS | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | BURTON | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2330 MONTEREY RD | ||||||||
| Address2: | |||||||||
| City: | SAN MARINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911081640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5628268000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5901 E 7TH ST | ||||||||
| Address2: | 111C | ||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908225201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5628268000 | ||||||||
| FaxNumber: | 5628265849 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | G83298 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.