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1730852179
DAVID WALLACE
NORTHRIDGE, CA
NPI
1730852179
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363A00000X Physician Assistant
(Licence: CA PA59863)
Enumeration Date
2021-07-30
Last Update Date
2021-07-30
Business Address
DAVID WALLACE PA-C
18350 ROSCOE BLVD # 702
NORTHRIDGE, CA 91325-4109
Phone number: 818-280-5961
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Mailing Address
DAVID WALLACE PA-C
793 ELM ST APT 7
SAN CARLOS, CA 94070-3076
Phone number: 650-862-9145
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