Provider Demographics
NPI:1669644514
Name:SABINA R WALLACH MD AMC
Entity Type:Organization
Organization Name:SABINA R WALLACH MD AMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SABINA
Authorized Official - Middle Name:R
Authorized Official - Last Name:WALLACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FRACP, FACP
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:92037-1224
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:92037-1224
Practice Address - Country:US
Practice Address - Phone:858-558-8666
Practice Address - Fax:858-558-9233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34070174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW22598Medicare PIN
CAD93465Medicare UPIN