Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Justin Cory Wallace, DIVEIDC

Individual provider Independent Duty Corpsman · NPI 1114354156

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 St
San Diego, CA 92101-7586
Phone: (760) 845-8116
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Independent Duty Corpsman (primary) Taxonomy 1710I1002X

Record details

NPI number1114354156
Entity typeIndividual (Type 1)
GenderMale
Credentials DIVEIDC
Sole proprietorNo
NPI enumeratedOctober 6, 2013
Last updated in NPPESOctober 6, 2013

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