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Azaia Wallace
NPI 1982287876 · on the registry since 2021
Practice
- Address
- 8039 Lennox Loop
Wesley Chapel, FL 33544 - Phone
- (918) 859-5775
Additional practice sites
- 6767 W Tropicana Ave Ste 100, Las Vegas, NV
Registry record
- Primary taxonomy
- 1041C0700X
1041C0700X
- Also registered as
- 104100000X
1041C0700X - Licence states on file
- NULL, NV
From the registry's licence fields, which are often incomplete.
- Sex
- Female
- Record last updated
- 2024-09-04
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Florida