Caronia Philesia Wallace-Fair, D.O.
Emergency Medicine, Pediatric Emergency Medicine in Madera, CA. Individual provider (NPI-1).
NPI number1982996195
StatusActive
Last updated in NPPESJul 21, 2022
Details
- NPI
- 1982996195
- Entity type
- Individual (NPI-1)
- Name
- Miss Caronia Philesia Wallace-Fair
- Credential
- D.O.
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- May 5, 2011
- Last updated
- Jul 21, 2022
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - PEDIATRIC MEDICINE
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility Yes · Hospice Yes
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207PP0204X | Emergency Medicine, Pediatric Emergency Medicine | 15444 | CA | Yes |
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – |
Other names
- Caronia Philesia Wallace (Other Name)
Practice location
9300 Valley Childrens PlMadera, CA 93636-8761
Phone 559-353-3000
Mailing address
39868 Avenue 7 1/2Madera, CA 93636
Phone 305-331-6955
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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