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Justin Wallace, DIVE IDC
NPI 1114354156 · on the registry since 2013
Practice
- Address
- 699 14th St
San Diego, CA 92101 - Phone
- (760) 845-8116
- Clinicians at this address
- 3
Registry record
- Primary taxonomy
- Independent Duty Corpsman
1710I1002X
- Sex
- Male
- Record last updated
- 2013-10-06
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