Individual
GREGORY ROY WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW
Contact information
Practice address
14545 SHERMAN CIR, VAN NUYS, CA 91405-3087
(818) 374-6901
Mailing address
14545 SHERMAN CIR, VAN NUYS, CA 91405-3087
(818) 374-6901
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Enumeration date
01/12/2015
Last updated
01/12/2015
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