Provider Demographics
NPI:1619296548
Name:WALL, DAVID M (MPA, PA-C)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:M
Last Name:WALL
Suffix:
Gender:M
Credentials:MPA, PA-C
Other - Prefix:
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Mailing Address - Street 1:8053 VALENCIA ST
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-4073
Mailing Address - Country:US
Mailing Address - Phone:831-688-8680
Mailing Address - Fax:831-688-8817
Practice Address - Street 1:1080 EMELINE AVE
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-1966
Practice Address - Country:US
Practice Address - Phone:831-454-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-17
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA20951363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant