Wallace, Mark S
Wallace, Mark S is an individual health care provider with primary practice located at Ucsd Medical Center 200 West Arbor Drive Mc 0801, San Diego CA 92103. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Anesthesiology, Allopathic & Osteopathic Physicians / Pain Medicine. Allopathic & Osteopathic Physicians / Pain Medicine is his primary health care specialty. Wallace, Mark S can be contacted via phone (619) 543-5720.Contact Information
Primary practice address
Ucsd Medical Center 200 West Arbor Drive Mc 0801
San Diego CA 92103
Phone: (619) 543-5720
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Anesthesiology | 207L00000X | G72906 | California |
| Allopathic & Osteopathic Physicians / Pain Medicine | 207LP2900X | G72906 | California |
Profile Details
| NPI number | 1427098102 |
|---|---|
| LBN Legal business name | Wallace, Mark S |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 8th, 2006 |
| Last updated | Aug 21st, 2018 - about 7 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1427098102 | NPPES |
| California | MEDICAID | 00G729060 |
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