Provider Demographics
NPI:1871529081
Name:WALLACH, SABINA ROSE (MD)
Entity type:Individual
Prefix:
First Name:SABINA
Middle Name:ROSE
Last Name:WALLACH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9850 GENESEE AVE
Mailing Address - Street 2:#400
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1212
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:#400
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1212
Practice Address - Country:US
Practice Address - Phone:858-558-8666
Practice Address - Fax:858-558-9233
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA34070207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A340700Medicaid
CAD93465Medicare UPIN
CA00A340700Medicaid