# WALL MEDICAL GROUP

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

## Provider details

- **NPI number:** 1427008135
- **Authorized official:** CATHERINE BROOKS (OFFICE MANAGER)
- **Authorized official phone:** (650) 636-1291

## Contact information

- **Practice address:** 455 GRAND AVE, SOUTH SAN FRANCISCO, CA 94080-3635
- **Practice address phone:** (650) 636-1286
- **Practice address fax:** (650) 588-4164
- **Mailing address:** 2001 UNION ST, SUITE 300, SAN FRANCISCO, CA 94123-4114
- **Mailing address phone:** (650) 636-1291

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207N00000X | Dermatology Physician | — | — | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 207VG0400X | Gynecology Physician | — | — | — |
| 207W00000X | Ophthalmology Physician | — | — | — |
| 207X00000X | Orthopaedic Surgery Physician | — | — | — |
| 208D00000X | General Practice Physician | ZZZ96273Z | CA | Yes |
| 225100000X | Physical Therapist | — | — | — |

## Other

- **Enumeration date:** 05/11/2006
- **Last updated:** 10/20/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | GR0020880 | MEDICAL | CA |