Individual
GERRI WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1448 E DEERFIELD ST, ONTARIO, CA 91761-7134
(310) 948-0013
Mailing address
1448 E DEERFIELD ST, ONTARIO, CA 91761-7134
(310) 948-0013
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Enumeration date
11/17/2016
Last updated
02/06/2017
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