Shane Wallin

NPI 1104282177 · on the registry since 2016 · sole proprietor

Practice

Address: 1968 Garnet Ave
San Diego, CA 92109
Phone: (612) 214-1325
Organisation at this address: Garnet Tattoo
Inferred from a shared address, not stated in the registry.

Additional practice sites

3073 Jefferson St, Napa, CA
4933 34th Ave S, Minneapolis, MN

Registry record

Primary taxonomy: 246ZA2600X
246ZA2600X
Licence states on file: MN
From the registry's licence fields, which are often incomplete.
Sex: Male
Record last updated: 2025-07-03

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in California