Ian Joseph Wallace PH.D.

NPI 1013143262 - Psychologist - 103T00000X

NPI Details
NPI 1013143262
Gender Male
Enumeration Date 06/02/2009
Last Updated 07/23/2013
Entity Type Individual
Active Over 7 years ago
Practice Location
200 MARITIME ACADEMY DR
THE CALIFORNIA MARITIME ACADEMY, STUDENT HEALTH SERVICE
VALLEJO CA, 94590-8181, US
Phone (707) 654-1170
Fax (707) 654-1171
Business Location
200 MARITIME ACADEMY DR
THE CALIFORNIA MARITIME ACADEMY, STUDENT HEALTH SERVICE
VALLEJO CA, 94590-8181, US
Phone (707) 654-1170
Fax (707) 654-1171
Toxanomy
Taxonomy Code 103T00000X
License State California
License Number PSY# 23646
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According to our database, Dr. Ian Joseph Wallace PH.D. NPI is 1013143262, taxonomy code is 103T00000X and license number is PSY# 23646, license state is located at California. Ian Joseph Wallace PH.D. physically located at 200 Maritime Academy Dr, Vallejo CA, 94590-8181. NPI Number Ian Joseph Wallace PH.D. has the Individual type.

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1013143262 NPI number is provided on an as is basis without warranty of any kind. 1013143262 is maintained by the National Plan & Provider Enumeration System. The contents of Ian Joseph Wallace PH.D. are for informational purposes only.