Individual
JOHNNY LEE WALLACE JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3401 WIBLE RD APT 91, BAKERSFIELD, CA 93309-6536
(760) 379-3412
Mailing address
PO BOX 1000, BAKERSFIELD, CA 93302-1000
(760) 379-3412
Taxonomy
Speciality
Code
Description
License number
State
373H00000X
Day Training/Habilitation Specialist
Primary
—
CA
Other
Enumeration date
12/05/2025
Last updated
12/08/2025
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