Individual
BRIAN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RADT 1
Contact information
Practice address
7907 OSTROW ST STE F, SAN DIEGO, CA 92111-3635
(858) 300-8282
Mailing address
7907 OSTROW ST STE F, SAN DIEGO, CA 92111-3635
(858) 300-8282
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
R1235971116
CA
Other
Enumeration date
01/27/2017
Last updated
09/13/2018
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