Individual
DR. DANIEL G WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3875 AVOCADO BLVD, LA MESA, CA 91941-7303
(800) 290-5000
Mailing address
393 E WALNUT ST, PASADENA, CA 91188-0001
(800) 290-5000
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
G71835
CA
Other
Enumeration date
07/06/2006
Last updated
11/30/2021
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