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Andrea Shanwtrae Wallace
Vehicle Modifications Contractor in San Bernardino, California
NPI 1154976777

Andrea Shanwtrae Wallace is a Vehicle Modifications Contractor based in San Bernardino, CA and is specialized in Vehicle Modifications. Andrea Shanwtrae Wallace practices in San Bernardino, CA. The NPI Number for Andrea Shanwtrae Wallace is 1154976777 and holds a License No. D6516086 (California).

The current practice location address for Andrea Shanwtrae Wallace is 2130 N Arrowhead Ave Ste 205B-1C, San Bernardino, CA and can be reached out via phone at 661-524-6038.

Location: 2130 N Arrowhead Ave Ste 205B-1C, San Bernardino, CA, 92405-4029
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1154976777
Provider Name
Andrea Shanwtrae Wallace
Credential
Provider Entity Type
Individual
Gender
Female
Address
2130 N Arrowhead Ave Ste 205B-1C, San Bernardino, CA, 92405-4029
Phone Number
661-524-6038
Fax Number
Provider Enumeration Date
08/09/2019
Last Update Date
03/10/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
90934505A95133 05 CA
institution
Provider Business Practice Location Address Details
Address
2130 N Arrowhead Ave Ste 205B-1C
City
San Bernardino
State
California
Zip
92405-4029
Phone Number
661-524-6038
Fax Number
person
Provider Business Mailing Address Details
Address
2130 N Arrowhead Ave Ste 205B-1C
City
San Bernardino
State
California
Zip
92405-4029
Phone Number
661-524-6038
Fax Number
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Contractor
Speciality
Vehicle Modifications
Taxonomy
171WV0202X
License No.
D6516086 (California)
Definition
A contractor who makes modifications to private vehicles to accommodate a health condition.
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