Individual
DR. MARK S WALLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
2001 SANTA MONICA BLVD, #1190W, SANTA MONICA, CA 90404-2102
(310) 828-0122
(310) 828-4463
Mailing address
1260 15TH ST, STE 1014, SANTA MONICA, CA 90404-1145
(310) 828-0122
(310) 828-4463
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
E3104
CA
Other
Enumeration date
02/21/2006
Last updated
01/21/2020
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