Individual
DR. WILLIAM W WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8933 ACTIVITY RD, SAN DIEGO, CA 92126-4427
(858) 653-6170
Mailing address
8933 ACTIVITY RD, SAN DIEGO, CA 92126-4427
(858) 653-6170
Taxonomy
Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
Primary
G17502
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G175020
—
CA
Enumeration date
08/31/2006
Last updated
07/08/2007
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