Individual
MARINA WALLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3853 ROSECRANS ST, SAN DIEGO, CA 92110-3115
(619) 692-8200
Mailing address
13355 N HWY 183 APT 1430, AUSTIN, TX 78750-7141
(281) 777-2462
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
95046963
CA
Other
Enumeration date
02/24/2015
Last updated
03/25/2021
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