Organization
HARVEY I. WALLACK, MD, A MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HARVEY I WALLACK M.D. (PRESIDENT/PHYSICIAN)
(805) 496-4459
Entity
Organization
Contact information
Practice address
227 W JANSS RD STE 125, THOUSAND OAKS, CA 91360-1856
(805) 496-4459
(805) 496-3250
Mailing address
227 W JANSS RD STE 125, THOUSAND OAKS, CA 91360-1856
(805) 496-4459
(805) 496-3250
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
G26513
CA
Other
Enumeration date
09/21/2006
Last updated
12/17/2007
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