Individual
BRIANNA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
490 N GRAPE ST, ESCONDIDO, CA 92025-3079
(760) 975-9939
Mailing address
8418 ROY ST, LEMON GROVE, CA 91945-2654
(619) 852-4864
Taxonomy
Speciality
Code
Description
License number
State
373H00000X
Day Training/Habilitation Specialist
Primary
—
—
Other
Enumeration date
05/22/2025
Last updated
05/22/2025
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