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Mr. Paul David Wallace
Licensed Psychiatric Technician in Stockton, California
NPI 1114044799

Paul David Wallace is a Licensed Psychiatric Technician based in Stockton, CA. Paul David Wallace practices in Stockton, CA. The NPI Number for Paul David Wallace is 1114044799 and holds a License No. PT 26296 (California).

The current practice location address for Paul David Wallace is 1212 N California St, Stockton, CA and can be reached out via phone at 209-468-3760.

Location: 1212 N California St, Stockton, CA, 95202-1552
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1114044799
Provider Name
Paul David Wallace
Credential
Provider Entity Type
Individual
Gender
Male
Address
1212 N California St, Stockton, CA, 95202-1552
Phone Number
209-468-3760
Fax Number
Provider Enumeration Date
03/26/2007
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
1212 N California St
City
Stockton
State
California
Zip
95202-1552
Phone Number
209-468-3760
Fax Number
person
Provider Business Mailing Address Details
Address
1212 N California St
City
Stockton
State
California
Zip
95202-1552
Phone Number
209-468-3760
Fax Number
person
Provider's Taxonomy Details 1
Type
Nursing Service Providers
Classification
Licensed Psychiatric Technician
Speciality
-
Taxonomy
167G00000X
License No.
PT 26296 (California)
Definition
An individual licensed by the state board as a Psychiatric Technician based upon completion of a prescribed course of theory and clinical practice, with two thirds of the clinical practice time focused on mental and developmental disorders. The psychiatric technician practices under the direct supervision of a physician, psychologist, registered nurse or other professional to provide care to patients with mental disorders and developmental disabilities.
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