Individual provider · Type 1 NPI

Miles Thomas Wallace, IDC

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

NPI number 1154085231 Active

Practice location

34800 Bob Wilson Dr
San Diego, CA 92134-1098

Call (619) 532-6400 Map

Specialties and licenses

TaxonomyCodeLicense
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 1154085231

Miles Thomas Wallace, IDC's National Provider Identifier is 1154085231, issued on Oct 26, 2021. 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 Jan 5, 2022.