Individual
FABIOLA CORBETTE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1790 BROADWAY STE 1802, NEW YORK, NY 10019-1471
(212) 530-0624
(415) 252-7176
Mailing address
1 EMBARCADERO CTR STE 1900, SAN FRANCISCO, CA 94111-3723
(415) 658-6791
(845) 338-0307
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
338132
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/26/2022
Last updated
11/07/2025
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