Justin Cory Wallace, DIVEIDC
Justin Cory Wallace, DIVEIDC is an Independent Duty Corpsman in San Diego, California. Registered with an NPI since 2013.
- In the registry since
- 2013
Practice location Address checks out
699 14th StSan Diego, CA 92101-7586
Phone: (760) 845-8116
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Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Independent Duty Corpsman (primary) | Taxonomy 1710I1002X |
|---|
Record details
| NPI number | 1114354156 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Male |
| Credentials | DIVEIDC |
| Sole proprietor | No |
| NPI enumerated | October 6, 2013 |
| Last updated in NPPES | October 6, 2013 |
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