| Doctor Name: | ELEANOR ANDREA WALLEN |
| NPI Number: | 1457394694 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | D.P.M. |
| License Number: | E3573 |
| Business Practice Address: | 4418 Vineland Ave Suite 215 Toluca Lake, CA - 916023457 |
| Business Phone Number: | 8189803383 |
| Business Fax Number: | 8189805383 |
| Mailing Address: | 4418 Vineland Ave, Suite 215 TOLUCA LAKE |
| State: | CA |
| Postal Code: | 916022159 |
| Phone Number: | 8189803383 |
| Fax Number: | 8189805383 |
| NPI Enumeration Date: | 06/14/2006 |
| NPI Last Update Date: | 09/28/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | E3573 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |