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Organization
WALL MEDICAL GROUP
Active
Organization
WALL MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CATHERINE BROOKS (OFFICE MANAGER)
(650) 636-1291
Entity
Organization
Contact information
Practice address
455 GRAND AVE, SOUTH SAN FRANCISCO, CA 94080-3635
(650) 636-1286
(650) 588-4164
Mailing address
2001 UNION ST, SUITE 300, SAN FRANCISCO, CA 94123-4114
(650) 636-1291
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
—
—
207Q00000X
Family Medicine Physician
—
—
207VG0400X
Gynecology Physician
—
—
207W00000X
Ophthalmology Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
208D00000X
General Practice Physician
Primary
ZZZ96273Z
CA
225100000X
Physical Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GR0020880
MEDICAL
CA
Enumeration date
05/11/2006
Last updated
10/20/2014
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