ROBERT WALLACE

OAKLAND, CA
NPI1720315336
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy363LF0000X Nurse Practitioner, Family
(Licence: CA  19738)
Additional Taxonomies363A00000X Physician Assistant
(Licence: CA  PA20650)
Enumeration Date2009-11-03
Last Update Date2012-06-11
Business Address
-- ROBERT WALLACE PA, NP
747 52ND ST
OAKLAND, CA 94609-1809
Phone number: 510-428-3022
Mailing Address
-- ROBERT WALLACE PA, NP
747 52ND ST
OAKLAND, CA 94609-1809
Phone number: 510-238-0121