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NPI Code Detail

MEDICARE: AARON WALLACE

MEDICARE:   AARON  WALLACE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225400000XRehabilitation PractitionerCA

General Provider Information

NPI Number : 1023107414
Entity Type Code : Individual
Provider Name (Legal Business Name) : AARON WALLACE
Provider Business Mailing Address
First Line : 1922 THE ALAMEDA STE 316
Second Line :
City : SAN JOSE
State : CA
Zip : 95126-1461
Country : US
Telephone Number : 408-261-7777
Fax Number :
Provider Business Practice Location Address
First Line : 1922 THE ALAMEDA STE 316
Second Line :
City : SAN JOSE
State : CA
Zip : 95126-1461
Country : US
Telephone Number : 408-261-7777
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2006
Last Update Date : 10/21/2025

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Directions to “ AARON WALLACE ” Practice Location

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