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1770006538
DEBRA ANN WALLACE
LOS ANGELES, CA
NPI
1770006538
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
2086S0122X Surgery, Plastic and Reconstructive Surgery
(Licence: CA 8326)
Enumeration Date
2017-07-24
Last Update Date
2018-06-16
Business Address
Mrs. DEBRA ANN WALLACE FNP
1100 N STATE STREET CLINIC TOWER A6A231A
LOS ANGELES, CA 90033
Phone number: 323-409-7788
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Mailing Address
Mrs. DEBRA ANN WALLACE FNP
4632 E VILLAGE RD
LONG BEACH, CA 90808-1545
Phone number: 323-409-7788
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