Individual
MS. KIMBERLEE ANN WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1664 BROADWAY, EL CAJON, CA 92021-5201
(619) 579-8685
Mailing address
1776 KEY LN, EL CAJON, CA 92021-1507
(619) 402-6278
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
11/20/2020
Last updated
11/20/2020
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