Ima Latoya Wallace
Ima Latoya Wallace is an Other Technician in Jacksonville, Florida. Practices as a sole proprietor. Registered with an NPI since 2022.
- In the registry since
- 2022
Practice location Address checks out
9951 Atlantic Blvd Ste 300Jacksonville, FL 32225-6574
Phone: (833) 434-5223
Fax: (888) 686-6271
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Specialties & licences
| Other Technician (primary) | Taxonomy 247200000X |
|---|
Record details
| NPI number | 1053063834 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Female |
| Sole proprietor | Yes |
| NPI enumerated | January 22, 2022 |
| Last updated in NPPES | June 17, 2022 |
| Certification date | June 17, 2022 |
| Mailing address | 9951 Atlantic Blvd Ste 300, Jacksonville, FL 32225-6574 |
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