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JUSTIN CORY WALLACE DIVE IDC
NPI 1114354156
Military Health Care Provider - Independent Duty Corpsman in San Diego, CA

Active since October 06, 2013
699 14TH ST, SAN DIEGO, CA 92101(760) 845-8116 Get Directions Write a Review

NPPES record last updated: October 6, 2013. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Justin Cory Wallace Dive Idc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JUSTIN CORY WALLACE DIVE IDC (NPI 1114354156) is an individual independent duty corpsman provider in San Diego, California and active in the NPI registry since October 2013.

NPPES Registry Identity

NPI1114354156
Entity TypeIndividualMale
Primary Taxonomy1710I1002X
Provider Legal NameJUSTIN CORY WALLACECredential: DIVE IDC
Location Address699 14TH STSan Diego, CA 92101-7586
Mailing Address699 14th StSan Diego, CA 92101-7586
Phone(760) 845-8116
Sole ProprietorNo
Enumeration DateOctober 6, 2013
✔ NPI 1114354156 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyMilitary Health Care Provider · Independent Duty CorpsmanOther Service Providers
Taxonomy Code1710I1002X
Definition
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.
699 14TH ST, San Diego, CA 92101
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Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

AARON WADE CHRISTENSEN SFIDC
Military Health Care Provider (Independent Duty Corpsman)
699 14TH ST
SAN DIEGO, CA 92101
San Diego County (205) 800-9807

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Justin Wallace's NPI number?

The NPI number for Justin Wallace is 1114354156. It was assigned to this individual provider in the NPPES registry on October 6, 2013.

Where is Justin Wallace located?

Justin Wallace practices at 699 14th St, San Diego, CA 92101. The listed phone number is (760) 845-8116.

What is Justin Wallace's specialty?

The primary specialty registered for this NPI is Military Health Care Provider, specializing in Independent Duty Corpsman, with taxonomy code 1710I1002X.

When was this NPI record last updated?

The NPPES record for Justin Wallace was last updated on October 6, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.