Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
MR. DEMETRIUS RICHARD WALLACE
ActiveMR. DEMETRIUS RICHARD WALLACE is a Community Health Worker healthcare provider located in VICTORVILLE, California. NPI 1073186540 is currently active in the NPPES registry. Verify at CMS.
Community Health Worker · VICTORVILLE, CA
Registration Details
- NPI Number
- 1073186540
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Jul 21, 2021 (4.9208399819359 yrs)
- Last Updated
- Jul 21, 2021
Practice Information
- Address
-
13733 ARTHUR DRVICTORVILLE, CA, 923920205Browse CA providers · Browse ZIP 92392
- Phone
- 7609120467
- Primary Specialty
-
Community Health Worker
172V00000X
Other Community Health Worker Providers in VICTORVILLE, CA
| Name | Credential | NPI |
|---|---|---|
| FREDERICK EVAN HUGHES | — | 1316027220 |
| MRS. MARIA ELLENA ACOSTA | — | 1851423495 |
| ERIC ALLISON | — | 1720254238 |
| JAMES WOODS | — | 1043457781 |
| LAKESHA JOY JOHNSON | — | 1275841173 |
| TAMMY LAJAUN MERRITT | — | 1376836320 |
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.