Individual
SHANE WALLIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1968 GARNET AVE, SAN DIEGO, CA 92109-3555
(612) 214-1325
Mailing address
1968 GARNET AVE, SAN DIEGO, CA 92109-3555
(619) 942-9737
Taxonomy
Speciality
Code
Description
License number
State
246ZA2600X
Medical Art Specialist/Technologist
Primary
310143
MN
Other
Enumeration date
01/06/2016
Last updated
07/03/2025
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