JUSTIN CORY WALLACE (NPI# 1114354156) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114354156 |
| Entity Type | Individual |
| Full Name | JUSTIN CORY WALLACE |
| Credential | DIVE IDC |
| Practice Address |
699 14th St San Diego CA 92101-7586 |
| Practice Telephone | 7608458116 |
| Enumeration Date | 2013-10-06 |
| Last Update Date | 2013-10-06 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1710I1002X |
Military Health Care Provider Specialization: Independent Duty Corpsman |
Other Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417331679 | Justin Matthew Wallace | Marriage & Family Therapist | 1322 E Shaw Ave Ste 410, Fresno, CA 93710-7904 | 2015-07-16 |
| 1649609728 | Justin K Wallace | Veterinarian | 120 S 6th St, Chickasha, OK 73018-3420 | 2013-11-08 |
| 1578807103 | Justin Covey Wallace | Registered Nurse | 4212 N 16th St, Phoenix, AZ 85016-5319 | 2012-11-20 |
| 1033372594 | Justin Robert Wallace | Surgery | 530 South St, Suite 380, Greensburg, PA 15601-2775 | 2008-07-05 |
| Street Address |
699 14TH ST |
| City | SAN DIEGO |
| State | CA |
| Zip Code | 92101-7586 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639501232 | Aaron Wade Christensen | Military Health Care Provider | 699 14th St, San Diego, CA 92101-7586 | 2013-08-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003415472 | Ryanleo Flores | Nurse Practitioner | 2017 1st Avenue, Suite 301, San Diego, CA 92101 | 2020-10-18 |
| 1265056048 | Tilbe Yildirim | Student in an Organized Health Care Education/Training Program | 1963 Fourth Ave., San Diego, CA 92101 | 2020-06-08 |
| 1235752585 | Liminal Solutions LLC | Home Health | 845 15th Street, Floors 1-4, San Diego, CA 92101 | 2020-05-21 |
| 1699258459 | Talya Donahue | Peer Specialist | 1045 Ninth Ave, San Diego, CA 92101 | 2018-09-07 |
| 1700380086 | Garfield Beach Cvs LLC | Durable Medical Equipment & Medical Supplies | 1850 5th Ave, San Diego, CA 92101 | 2018-03-21 |
| 1013436161 | Yasmin Galicianava | Student in an Organized Health Care Education/Training Program | 734 Tenth Ave, San Diego, CA 92101 | 2017-09-10 |
| 1487172516 | Jessica Roach | Counselor | 1045 9th Avenue, San Diego, CA 92101 | 2017-09-09 |
| 1699204099 | Lisa Nunez | Student in an Organized Health Care Education/Training Program | 1963 4th Avenue, San Diego, CA 92101 | 2017-06-08 |
| 1356882245 | Dajah Mone't Lockett | Counselor | 2535 Kettner Blvd Suite 1a4, San Diego, CA 92101 | 2017-03-13 |
| 1649718495 | Luigi Bunyi | Behavior Technician | 501 W Broadway Suite 800, San Diego, CA 92101 | 2017-02-01 |
| Find all providers in zip 92101 | ||||
| Taxonomy Code | 1710I1002X |
| Grouping | Other Service Providers |
| Classification | Military Health Care Provider |
| Specialization | Independent Duty Corpsman |
| A Navy Independent Duty Corpsman (IDC) is an active duty Sailor who has successfully completed one of the Navy's specific IDC training programs. IDCs are formally trained and educated to perform primary medical care and minor surgical services in a variety of health care and non-health care settings worldwide under indirect physician supervision. IDCs provide care to Department of Defense operational forces and other supporting forces such as contractors and foreign nationals. |
| Notes: Source: Bureau of Medicine and Surgery, Department of the Navy [7/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770180648 | Darius Lee Sean Woods | Military Health Care Provider | 6033 Sandy Shore Ct, San Diego, CA 92139-1014 | 2020-10-05 |
| 1174130744 | Daniel Carrera | Military Health Care Provider | 2645 W Canyon Ave Apt 450, San Diego, CA 92123-4700 | 2020-09-28 |
| 1316551740 | Kyle Bode Francis | Military Health Care Provider | 3149 Murray Ridge Rd, San Diego, CA 92123-2917 | 2020-09-02 |
| 1255945069 | Jeremy Lee | Military Health Care Provider | 509 Dennery Rd Apt 145, San Diego, CA 92154-8542 | 2020-08-31 |
| 1013520667 | Rashaad Brown | Military Health Care Provider | 4454 Cherokee Ave Apt 2, San Diego, CA 92116-3611 | 2020-08-24 |
| 1932711934 | Alvaro Daniel Macias | Military Health Care Provider | 8685 Rio San Diego Dr Apt 4344, San Diego, CA 92108-6560 | 2020-08-20 |
| 1689286189 | Charles Luke Morris | Military Health Care Provider | 1675 Beta Ct, San Diego, CA 92126-7060 | 2020-08-18 |
| 1255943635 | Stephon Peyton Frost | Military Health Care Provider | 2654 Mendonca Dr, San Diego, CA 92110-4263 | 2020-08-18 |
| 1184235871 | Jaden Sandi | Military Health Care Provider | Swmi Sfidc Bldg 14 34101 Farenholt Ave, San Diego, CA 92134-0001 | 2020-08-14 |
| 1477178457 | Joseph Hunter Sampson | Military Health Care Provider | 34101 Farenholt Ave #14, San Diego, CA 92134 | 2020-06-15 |
| Find all providers in SAN DIEGO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.