Miles Thomas Wallace, IDC is a student in an organized health care education training program in San Diego, CA. The provider is 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. Miles Thomas Wallace, IDC NPI is 1154085231. 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:
34800 BOB WILSON DR
SAN DIEGO, CA
ZIP 92134-098
Phone: (619) 532-6400
The enumeration date for this NPI number is 10/26/2021 and was last updated on 1/5/2022.