Wallace, Jackylin Jill
Wallace, Jackylin Jill is an individual health care provider with primary practice located at 2731 Nugget Ave , Lake Isabella CA 93240-9456. She recently has only one registered license in Other Service Providers / Community Health Worker, which is considered as her primary health care specialty. Wallace, Jackylin Jill can be contacted via phone (760) 379-3412.Contact Information
Primary practice address
2731 Nugget Ave
Lake Isabella CA 93240-9456
Phone: (760) 379-3412
Fax: (760) 379-5332
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Community Health Worker | 172V00000X | California |
Profile Details
| NPI number | 1073247912 |
|---|---|
| LBN Legal business name | Wallace, Jackylin Jill |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 15th, 2022 |
| Last updated | Aug 15th, 2023 - about last year |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1073247912 | NPPES |
| California | MEDICAID | 172V00000X |
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