Individual
MR. DEMETRIUS RICHARD WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
13733 ARTHUR DR, VICTORVILLE, CA 92392-0205
(760) 912-0467
Mailing address
PO BOX 1477, VICTORVILLE, CA 92393-1477
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
07/21/2021
Last updated
07/21/2021
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