Individual
CHRISTINA N WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MASSAGE PRACTIONER
Contact information
Practice address
308 OAK STREET, PENNGROVE, CA 94951
(707) 431-1223
Mailing address
PO BOX 853, PENNGROVE, CA 94951-0853
(707) 431-1223
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
30660
CA
Other
Enumeration date
09/04/2020
Last updated
09/04/2020
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