Individual
DR. STACEY J. WALLACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4860 Y ST, OB/GYN, SUITE 2500, ACC, SACRAMENTO, CA 95817-2307
(916) 734-6930
(916) 734-6666
Mailing address
4860 Y ST, OB/GYN, SUITE 2500, ACC, SACRAMENTO, CA 95817-2307
(916) 734-6930
(916) 734-6666
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
G68624
CA
207VF0040X
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
Primary
A68624
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A686240
—
CA
Enumeration date
11/30/2005
Last updated
12/06/2016
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