Individual
ANDREA NAMON WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9808 VENICE BLVD STE 700, CULVER CITY, CA 90232-6824
(310) 945-3350
(310) 945-3356
Mailing address
9808 VENICE BLVD STE 700, CULVER CITY, CA 90232-6824
(310) 945-3350
(310) 945-3356
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
09/17/2019
Last updated
09/17/2019
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