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General NPI Number Information
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NPI Number | 1457515587
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Entity Type | Individual
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Provider Name | STEVEN EARL WALLACE RPA
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Gender | Male
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Dates
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Enumeration Date | 07/17/2008
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Last Update Date | 07/17/2008
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Provider Practice Location Address
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Address Line | 1065 BUCKS LAKE RD
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City | QUINCY
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State | CA
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Zip | 95971-9507
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Country | US
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Telephone | 530-283-7155
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Fax | 530-283-1838
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Provider Business Mailing Address
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Address Line | 2704 RIDGERUN RD
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City | QUINCY
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State | CA
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Zip | 95971-9380
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Country | US
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Telephone | 530-283-3504
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Fax | 530-283-1838
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZA2600X
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Taxonomy Name | Medical Art Specialist/Technologist
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License Number | 243U00000X
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License Number State |
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