=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871529081
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SABINA ROSE WALLACH M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/23/2006
-----------------------------------------------------
Last Update Date | 08/16/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9850 GENESEE AVE #400
-----------------------------------------------------
City | LA JOLLA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92037-1212
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-558-8666
-----------------------------------------------------
Fax | 858-558-9233
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9850 GENESEE AVE #400
-----------------------------------------------------
City | LA JOLLA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92037-1212
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-558-8666
-----------------------------------------------------
Fax | 858-558-9233
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RH0003X
-----------------------------------------------------
Taxonomy Name | Hematology & Oncology Physician
-----------------------------------------------------
License Number | A34070
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------