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Justin Wallace, DIVE IDC
NPI 1114354156 · Independent Duty Corpsman · San Diego, CA
Justin Wallace, DIVE IDC is a Independent Duty Corpsman provider in San Diego, CA (NPI 1114354156).
Provider details
- NPI number
- 1114354156
- Entity type
- Individual
- Primary specialty
- Independent Duty CorpsmanOther Service Providers
- Credential
- DIVE IDC
- Sex
- Male
- Sole proprietor
- No
Specialties & taxonomies
Other Service Providers
Profile Score
Established profile(70/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
12 yrs in NPPES registry
- Profile completeness38% of score
83% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
699 14th St
San Diego, CA 92101-7586
Phone: (760) 845-8116
Street-level locationGet directions
Mailing address
699 14th St
San Diego, CA 92101-7586
Registry dates
- Enumerated
- 2013-10-06
- Last updated
- 2013-10-06
Frequently asked questions
- What is Justin Wallace's NPI number?
- Justin Wallace's National Provider Identifier (NPI) is 1114354156, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What is Justin Wallace's specialty?
- Justin Wallace is listed in the NPPES registry with a primary specialty of Independent Duty Corpsman (Other Service Providers).
- Where is Justin Wallace located?
- Justin Wallace's practice location on file with NPPES is 699 14th St, San Diego, CA 92101-7586.
- What is Justin Wallace's phone number?
- The practice phone number listed in the NPPES registry for Justin Wallace is (760) 845-8116.
- Is Justin Wallace's NPI active?
- Yes — Justin Wallace's NPI (1114354156) is active in the NPPES registry as of the last update on 2013-10-06.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.