NPI 1003101775

Christopher a Wallace, IDC

Practitioner Independent Duty Corpsman San Diego, CA

Practice location

Address: 34101 Farenholt Ave, San Diego, CA 92134-5000
Phone: (619) 532-7801

Registered specialties

Independent Duty Corpsman Primary

Other Service Providers Taxonomy 1710I1002X

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Registry record

NPI: 1003101775
Entity type: Individual
Sex (as registered): Male
NPI issued: 10 Jun 2011
Record last updated: 10 Jun 2011

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.