Wallace, Sergio
Wallace, Sergio is an sole proprietor health care provider with primary practice located at 8201 Canterbury Lake Blvd , Tampa FL 33619-6671. He recently has only one registered license in Behavioral Health & Social Service Providers / Behavior Technician, which is considered as his primary health care specialty. Wallace, Sergio can be contacted via phone (727) 657-8299.Contact Information
Primary practice address
8201 Canterbury Lake Blvd
Tampa FL 33619-6671
Phone: (727) 657-8299
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Behavior Technician | 106S00000X |
Profile Details
| NPI number | 1720525728 |
|---|---|
| LBN Legal business name | Wallace, Sergio |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jan 27th, 2017 |
| Last updated | Jan 27th, 2017 - about 9 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1720525728 | NPPES |
| Florida | MEDICAID | 656425 |
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