Individual
DR. BECKY L WALLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2400 SAMARITAN DR, SUITE 203, SAN JOSE, CA 95124-3910
(408) 879-9941
Mailing address
2350 W EL CAMINO REAL, 2ND FLOOR, MOUNTAIN VIEW, CA 94040-6201
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
A55243
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05D1002837
CLIA
CA
01
—
A55243
STATE LICENSE
CA
01
—
P00118398
MEDICARE RAILROAD
CA
Enumeration date
05/08/2006
Last updated
03/07/2023
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