Individual provider · Type 1 NPI
Brandon M. Wallace, DPM
Foot & Ankle Surgery Podiatrist · West Covina, CA
NPI number
1316426679
Active
Practice location
1300 S Sunset Ave
West Covina, CA 91790-3342
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Foot & Ankle Surgery Podiatrist Primary | 213ES0103X | E5705 (CA) |
Foot & Ankle Surgery Podiatrist: Definition to come...
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About NPI 1316426679
Brandon M. Wallace, DPM's National Provider Identifier is 1316426679, issued on Aug 8, 2018. The primary taxonomy on file is Foot & Ankle Surgery Podiatrist (213ES0103X), and the practice location is in West Covina, CA. The record was last updated on Nov 6, 2025.