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Individual

DR. IAN JOSEPH WALLACE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PH.D.

Contact information

Practice address
200 MARITIME ACADEMY DR, THE CALIFORNIA MARITIME ACADEMY, STUDENT HEALTH SERVICE, VALLEJO, CA 94590-8181
(707) 654-1170
(707) 654-1171
Mailing address
200 MARITIME ACADEMY DR, THE CALIFORNIA MARITIME ACADEMY, STUDENT HEALTH SERVICE, VALLEJO, CA 94590-8181
(707) 654-1170
(707) 654-1171

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY# 23646
CA

Other

Enumeration date
06/02/2009
Last updated
07/23/2013
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