Healthcare Provider Details

I. General information

NPI: 1962051045
Provider Name (Legal Business Name): MORIAH CHARLOTTE WOLFE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2019
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3075 ADELINE ST STE 120
BERKELEY CA
94703-2579
US

IV. Provider business mailing address

3075 ADELINE ST STE 120
BERKELEY CA
94703-2579
US

V. Phone/Fax

Practice location:
  • Phone: 510-848-1112
  • Fax: 510-848-4445
Mailing address:
  • Phone: 510-848-1112
  • Fax: 510-848-4445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: