Wallace, Justin Cory

Wallace, Justin Cory is an individual health care provider with primary practice located at 699 14Th St , San Diego CA 92101-7586. He recently has only one registered license in Other Service Providers / Independent Duty Corpsman, which is considered as his primary health care specialty. Wallace, Justin Cory can be contacted via phone (760) 845-8116.

Contact Information

Primary practice address
699 14Th St San Diego CA 92101-7586
Phone: (760) 845-8116
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Independent Duty Corpsman 1710I1002X

Profile Details

NPI number 1114354156
LBN Legal business name Wallace, Justin Cory
Credentials DIVE IDC
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 6th, 2013
Last updated Oct 6th, 2013 - about 11 years ago

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.

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