Individual
MISS CARONIA PHILESIA WALLACE-FAIR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
9300 VALLEY CHILDRENS PL, MADERA, CA 93636-8761
(559) 353-3000
Mailing address
39868 AVENUE 7 1/2, MADERA, CA 93636
(305) 331-6955
Taxonomy
Speciality
Code
Description
License number
State
207PP0204X
Pediatric Emergency Medicine (Emergency Medicine) Physician
Primary
15444
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/05/2011
Last updated
07/21/2022
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