Individual
DR. BRANDON M WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
1300 S SUNSET AVE, WEST COVINA, CA 91790-3342
(323) 269-5205
Mailing address
1300 S SUNSET AVE, WEST COVINA, CA 91790-3342
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
E5705
CA
Other
Enumeration date
08/08/2018
Last updated
11/06/2025
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