Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | G68624 | CA |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | A68624 | CA |
NPI | 1891779369 |
---|---|
Provider Name | Dr. Stacey J. Wallach |
First Address | Sacramento, CA 95817-2307 |
Second Address | Sacramento, CA 95817-2307 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2005 |
Last Update Date | 06/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A686240 | (05) | CA |
G96323 | (02) | CA |