Healthcare Provider Details

I. General information

NPI: 1205871142
Provider Name (Legal Business Name): MARC D. WOLFSOHN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 12/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 PASEO CAMARILLO
CAMARILLO CA
93010
US

IV. Provider business mailing address

P.O. BOX 5457
SAN LUIS OBISPO CA
93403
US

V. Phone/Fax

Practice location:
  • Phone: 805-484-8558
  • Fax: 805-484-3099
Mailing address:
  • Phone: 805-484-8558
  • Fax: 805-484-3099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberG34454
License Number StateCA

VIII. Authorized Official

Name: DR. MARC D. WOLFSOHN
Title or Position: DIRECTOR/OWNER
Credential: MD
Phone: 805-484-8558