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1629709373
ISHMIEL WALLACE
GARDEN GROVE, CA
NPI
1629709373
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
106S00000X Behavior Technician
Enumeration Date
2022-06-23
Last Update Date
2022-06-23
Business Address
ISHMIEL WALLACE
12465 LEWIS ST STE 102
GARDEN GROVE, CA 92840-4658
Phone number: 855-223-7123
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Mailing Address
ISHMIEL WALLACE
16782 VON KARMAN AVE STE 11
IRVINE, CA 92606-2417
Phone number: 855-223-7123
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