Individual
TAMMI WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9890 COUNTY FARM RD STE 3, RIVERSIDE, CA 92503-3678
(951) 509-8320
Mailing address
1116 CLOVERDALE ST, RIVERSIDE, CA 92501-1540
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
04/15/2022
Last updated
04/15/2022
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