Wallace, Paul Wesley

Wallace, Paul Wesley is an individual health care provider with primary practice located at 8920 Wilshire Blvd Suite 327, Beverly Hills CA 90211-2007. He recently has only one registered license in Allopathic & Osteopathic Physicians / Dermatology, which is considered as his primary health care specialty. Wallace, Paul Wesley can be contacted via phone (310) 652-8460.

Contact Information

Primary practice address
8920 Wilshire Blvd Suite 327 Beverly Hills CA 90211-2007
Phone: (310) 652-8460
Fax: (310) 652-8499
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Dermatology 207N00000X A049918 California

Profile Details

NPI number 1063494474
LBN Legal business name Wallace, Paul Wesley
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 19th, 2005
Last updated Oct 16th, 2007 - about 17 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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Identifiers

StateTypeNumberIssuer
All States NPI 1063494474 NPPES
California MEDICAID 00A499180

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