Individual
DR. PAUL WESLEY WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8920 WILSHIRE BLVD, SUITE 327, BEVERLY HILLS, CA 90211-2007
(310) 652-8460
(310) 652-8499
Mailing address
8920 WILSHIRE BLVD, SUITE 327, BEVERLY HILLS, CA 90211-2007
(310) 652-8460
(310) 652-8499
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
A049918
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A499180
—
CA
Enumeration date
11/19/2005
Last updated
10/16/2007
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