| NPI | 1659978328 |
|---|---|
| Doing Business As | LA TANYA WALLACE, NP |
| Entity Type | Organization |
| Authorized Contact | LA TANYA WALLACE President 619-398-7473 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2020-10-06 |
| Last Update Date | 2024-01-28 |