Organization
WALLACE MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL WESLEY WALLACE M.D. (PRESIDENT)
(310) 652-8460
Entity
Organization
Contact information
Practice address
8920 WILSHIRE BLVD, #327, BEVERLY HILLS, CA 90211-2007
(310) 652-8460
(310) 652-8499
Mailing address
8920 WILSHIRE BLVD, #327, BEVERLY HILLS, CA 90211-2003
(310) 652-8460
(310) 652-8499
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
A49918
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0062021
—
CA
Enumeration date
09/26/2006
Last updated
10/11/2007
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