Justin Cory Wallace, DIVE IDC is an independent duty corpsman military health care provider in San Diego, CA. The provider is a Navy Independent Duty Corpsman (IDC) is an active duty Sailor who has successfully completed one of the Navy's specific IDC training programs. IDCs are formally trained and educated to perform primary medical care and minor surgical services in a variety of health care and non-health care settings worldwide under indirect physician supervision. IDCs provide care to Department of Defense operational forces and other supporting forces such as contractors and foreign nationals. Justin Cory Wallace, DIVE IDC NPI is 1114354156. The provider is registered as an individual entity type.
The NPPES NPI record indicates the provider is a male.
The provider's business location address is:
699 14TH ST
SAN DIEGO, CA
ZIP 92101-586
Phone: (760) 845-8116
The enumeration date for this NPI number is 10/6/2013 and was last updated on 10/6/2013.