Individual
DR. DANIEL J WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8750 WILSHIRE BLVD STE 210, BEVERLY HILLS, CA 90211-2703
(310) 652-0920
(310) 652-2482
Mailing address
PO BOX 18736, BEVERLY HILLS, CA 90209-4736
(310) 652-0920
(310) 360-4812
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
Primary
G30533
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
953744782
BLUE CROSS
CA
01
—
PG0080544002
BLUE SHIELD OF CA
CA
Enumeration date
06/09/2005
Last updated
03/22/2022
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