Provider Demographics
NPI:1376735886
Name:SABINA R. WALLACH, M.D. A MEDICAL CORP
Entity Type:Organization
Organization Name:SABINA R. WALLACH, M.D. A MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-558-8666
Mailing Address - Street 1:9850 GENESEE AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1212
Mailing Address - Country:US
Mailing Address - Phone:858-558-8666
Mailing Address - Fax:858-558-9233
Practice Address - Street 1:9850 GENESEE AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1212
Practice Address - Country:US
Practice Address - Phone:858-558-8666
Practice Address - Fax:858-558-8666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34070174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty