Organization
WALLACE MEDICAL GROUP, INC
Active
Organization
WALLACE MEDICAL GROUP, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAUL WESLEY WALLACE M.D. (MEDICAL DIRECTOR)
(310) 652-8460
Entity
Organization
Contact information
Practice address
8920 WILSHIRE BLVD, SUITE 327, BEVERLY HILLS, CA 90211-2007
(310) 652-8460
Mailing address
8920 WILSHIRE BLVD, SUITE 327, BEVERLY HILLS, CA 90211-2007
(310) 652-8460
Taxonomy
Speciality
Code
Description
License number
State
207NS0135X
Procedural Dermatology Physician
Primary
A49918
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0062020
—
CA
Enumeration date
05/01/2007
Last updated
10/16/2007
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