# LYDIA V. WALLACE, D.O., P.A.

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1861766941
- **Authorized official:** DR. LYDIA VALLADARES WALLACE D.O. (OWNER)
- **Authorized official phone:** (954) 721-8202

## Contact information

- **Practice address:** 3021 N 66TH AVE, HOLLYWOOD, FL 33024-2925
- **Practice address phone:** (754) 281-8202
- **Mailing address:** 3021 N 66TH AVE, HOLLYWOOD, FL 33024-2925
- **Mailing address phone:** (754) 281-8202

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QC1500X | Community Health Clinic/Center | OS 10688 | FL | Yes |

## Other

- **Enumeration date:** 03/07/2012
- **Last updated:** 03/07/2012