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Timothy M Wallace

  • Male

Medical Specialty

Professional ID

  • NPI: 1063438307
  • PECOS ID: 8628238573
  • Enrollment ID: I20120329000730
  • Credential(MD, DO, DPM):
  • Medical School: Los Angeles College Of Chiropractic
  • Medical School Graduation Year: 1999

Location

  • Address1: 4357 Phelan Rd
  • Address2:
  • City: Phelan
  • State: California
  • Zip Code: 92371
  • Phone Number: (760)868-4481

Medicare

  • Medicare Assignment: Maybe
  • Report Quality of Care to Physician Quality Reporting System (PQRS):
  • Used Electronic health record (EHR):