Individual
DAVID WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
18350 ROSCOE BLVD # 702, NORTHRIDGE, CA 91325-4109
(818) 280-5961
(818) 280-5983
Mailing address
18350 ROSCOE BLVD # 702, NORTHRIDGE, CA 91325-4109
(818) 280-5961
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA59863
CA
Other
Enumeration date
07/30/2021
Last updated
08/28/2025
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