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1790442408
SCOTT DAVID WALLACE
FAIRFIELD, CA
NPI
1790442408
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
363LF0000X Nurse Practitioner, Family
(Licence: CA 459083)
Enumeration Date
2021-11-17
Last Update Date
2021-11-17
Business Address
SCOTT DAVID WALLACE NP
513 SILVERADO CIR
FAIRFIELD, CA 94534-6818
Phone number: 707-864-3240
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Mailing Address
SCOTT DAVID WALLACE NP
513 SILVERADO CIR
FAIRFIELD, CA 94534-6818
Phone number: 707-864-3240
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