Organization
DONALD E WALLENS MD A MEDICAL CORP
Active
Other names
Donald E Wallens MD A Medical Corporation
Organization subpart
No
Provider details
NPI number
Authorized official
SHARON SINDELL (ASSISTANT)
(310) 556-2095
Entity
Organization
Contact information
Practice address
2080 CENTURY PARK E STE 1406, LOS ANGELES, CA 90067-2017
(310) 556-2095
(310) 556-2063
Mailing address
2080 CENTURY PARK E STE 1406, LOS ANGELES, CA 90067-2017
(310) 556-2095
(310) 556-2063
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
G12632
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AW4316546
MEDICARE ID-TYPE UNSPECIFIED
CA
Enumeration date
07/06/2010
Last updated
09/24/2020
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