1144118886 NPI number — UNION OF PAN ASIAN COMMUNITIES

Table of content: LUCY BROOKS WALLACE M.D. (NPI 1770787566)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144118886 NPI number — UNION OF PAN ASIAN COMMUNITIES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNION OF PAN ASIAN COMMUNITIES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144118886
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/02/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3288 EL CAJON BLVD STE 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92104-1430
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-521-5720
Provider Business Mailing Address Fax Number:
619-521-5728

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6905 SKYLINE DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-521-5720
Provider Business Practice Location Address Fax Number:
619-521-5728
Provider Enumeration Date:
06/24/2025

Additional Information

Authorized Official

Authorized Official Last Name:
BOATMAN
Authorized Official First Name:
COURTNEY
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
619-521-5720

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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