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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