Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 835960 | CA |
NPI | 1033293394 |
---|---|
Provider Name | Dr. Stuart Wolf |
First Address | South Gate, CA 90280-1867 |
Second Address | South Gate, CA 90280-6045 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2006 |
Last Update Date | 26/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A359600 | (05) | CA |