Provider Demographics
NPI:1366984999
Name:WALLACH WOMENS WELLNESS
Entity type:Organization
Organization Name:WALLACH WOMENS WELLNESS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLACH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-579-1127
Mailing Address - Street 1:1900 LITTLE RAVEN ST
Mailing Address - Street 2:APT 522
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-7163
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1900 LITTLE RAVEN ST
Practice Address - Street 2:APT 522
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-7163
Practice Address - Country:US
Practice Address - Phone:954-579-1127
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-14
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty