Search › California › 172V00000X
Jackylin Wallace
NPI 1073247912 · on the registry since 2022
Practice
- Address
- 2731 Nugget Ave
Lake Isabella, CA 93240 - Phone
- (760) 379-3412
- Fax
- (760) 379-5332
- Organisation at this address
- College Community Services
Inferred from a shared address, not stated in the registry.
- Clinicians at this address
- 85
Registry record
- Primary taxonomy
- 172V00000X
172V00000X
- Licence states on file
- CA
From the registry's licence fields, which are often incomplete.
- Sex
- Female
- Record last updated
- 2023-08-15
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in California