Individual
DENISE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
801 E CHAPMAN AVE, SUITE #203, FULLERTON, CA 92831-3839
(714) 680-9000
(714) 680-8233
Mailing address
PO BOX 919, FULLERTON, CA 92836-0919
(714) 680-9000
(714) 680-8233
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Enumeration date
10/20/2016
Last updated
09/25/2017
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