Organization
MARK S. WALLEN, D.P.M., INC.
Active
Organization
MARK S. WALLEN, D.P.M., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK S. WALLEN DPM (OWNER)
(310) 828-0122
Entity
Organization
Contact information
Practice address
2001 SANTA MONICA BLVD, 1190 W, SANTA MONICA, CA 90404-2102
(310) 828-0122
(310) 828-4463
Mailing address
2001 SANTA MONICA BLVD, 1190 W, SANTA MONICA, CA 90404-2102
(310) 828-0122
(310) 828-4463
Taxonomy
Speciality
Code
Description
License number
State
213ES0131X
Foot Surgery Podiatrist
Primary
E 3104
CA
Other
Enumeration date
07/05/2006
Last updated
11/13/2009
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