Individual
DR. CHARLES DOUGLAS WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3030 CHILDRENS WAY, STE 410, SAN DIEGO, CA 92123-4232
(858) 966-6789
(858) 966-8519
Mailing address
3860 CALLE FORTUNADA, STE #210, SAN DIEGO, CA 92123-4802
(858) 309-6303
(858) 309-6301
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
G67953
CA
Other
Enumeration date
07/18/2005
Last updated
11/02/2011
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