Individual
TREVOR WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
315 RECORD ST STE 103, RENO, NV 89512-3327
(775) 405-4111
(775) 622-8611
Mailing address
1733 N DOLLNER CT, VISALIA, CA 93291-1932
(559) 731-2833
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
11/01/2013
Last updated
04/16/2020
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