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General NPI Number Information
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NPI Number | 1679169783
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Entity Type | Individual
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Provider Name | WALLACE HENRY TORBERT III PA-C
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Gender | Male
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Dates
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Enumeration Date | 12/14/2020
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Last Update Date | 04/21/2025
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Provider Practice Location Address
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Address Line | 1 EMBARCADERO CTR FL 19
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City | SAN FRANCISCO
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State | CA
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Zip | 94111-3628
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Country | US
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Telephone | 415-658-6791
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Fax | 415-252-7176
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Provider Business Mailing Address
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Address Line | 1 EMBARCADERO CTR FL 19
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City | SAN FRANCISCO
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State | CA
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Zip | 94111-3628
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Country | US
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Telephone |
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA101520
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 010232
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 11007
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License Number State | AZ
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA.0009167
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License Number State | CO
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Taxonomy #5
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9116491
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License Number State | FL
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