Individual
ELEANOR ANDREA WALLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.P.M.
Contact information
Practice address
4418 VINELAND AVE, SUITE 215, TOLUCA LAKE, CA 91602-3457
(818) 980-3383
(818) 980-5383
Mailing address
4418 VINELAND AVE, SUITE 215, TOLUCA LAKE, CA 91602-2159
(818) 980-3383
(818) 980-5383
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
E3573
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
W21231
MEDICARE PTAN GROUP
CA
Enumeration date
06/14/2006
Last updated
09/28/2009
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