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1164570065
DEBRA R WALLACE
PANORAMA CITY, CA
NPI
1164570065
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363L00000X Nurse Practitioner
(Licence: CA 006248)
Enumeration Date
2007-01-08
Last Update Date
2021-11-30
Business Address
DEBRA R WALLACE NP
13652 CANTARA ST
PANORAMA CITY, CA 91402-5423
Phone number: 818-375-2000
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Mailing Address
DEBRA R WALLACE NP
13652 CANTARA ST
PANORAMA CITY, CA 91402-5423
Phone number: 818-375-2000
Copy
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