Wallace, Mark S

Wallace, Mark S is an individual health care provider with primary practice located at Ucsd Medical Center 200 West Arbor Drive Mc 0801, San Diego CA 92103. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Anesthesiology, Allopathic & Osteopathic Physicians / Pain Medicine. Allopathic & Osteopathic Physicians / Pain Medicine is his primary health care specialty. Wallace, Mark S can be contacted via phone (619) 543-5720.

Contact Information

Primary practice address
Ucsd Medical Center 200 West Arbor Drive Mc 0801 San Diego CA 92103
Phone: (619) 543-5720
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Anesthesiology 207L00000X G72906 California
Allopathic & Osteopathic Physicians / Pain Medicine 207LP2900X G72906 California

Profile Details

NPI number 1427098102
LBN Legal business name Wallace, Mark S
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 8th, 2006
Last updated Aug 21st, 2018 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1427098102 NPPES
California MEDICAID 00G729060

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