Individual
BARRY JAY WALLMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
29525 CANWOOD ST, #305, AGOURA HILLS, CA 91301-4233
(818) 707-7789
(818) 707-7797
Mailing address
29525 CANWOOD ST, #305, AGOURA HILLS, CA 91301-4233
(818) 707-7789
(818) 707-7797
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
G58527
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1952318461
NPI NUMBER INDIVIDUAL
CA
01
—
CB227753
PTAN
CA
Enumeration date
08/01/2006
Last updated
04/22/2015
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