Healthcare Provider Details

I. General information

NPI: 1487910717
Provider Name (Legal Business Name): THOMAS ROBERT WOLFF BLAIR M.D. (JUNE 2012)
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2012
Last Update Date: 11/18/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9449 IMPERIAL HWY A206 (ORCHARD, BEH HEALTH)
DOWNEY CA
90242-2814
US

IV. Provider business mailing address

9449 IMPERIAL HWY A206 (ORCHARD, BEH HEALTH)
DOWNEY CA
90242-2814
US

V. Phone/Fax

Practice location:
  • Phone: 562-807-6200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA127318
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA127318
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: