Individual provider · Type 1 NPI

Sommer Sade' Wallace, M. DIV

Student in an Organized Health Care Education/Training Program · San Diego, CA

NPI number 1083267751 Active

Practice location

3491 Kurtz St Ste 150
San Diego, CA 92110-4430

Call (619) 320-2404 Map

Specialties and licenses

TaxonomyCodeLicense
Counselor 101Y00000XNone listed
Case Manager/Care Coordinator 171M00000XNone listed
Rehabilitation Practitioner 225400000XNone listed
Student in an Organized Health Care Education/Training Program Primary 390200000XNone listed

Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

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About NPI 1083267751

Sommer Sade' Wallace, M. DIV's National Provider Identifier is 1083267751, issued on Jul 22, 2019. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in San Diego, CA. The record was last updated on Sep 8, 2025.