Healthcare Provider Details

I. General information

NPI: 1720191729
Provider Name (Legal Business Name): PAUL SERGEI WOLF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 08/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1189 E HERNDON AVE SUITE 101
FRESNO CA
93720-3167
US

IV. Provider business mailing address

1189 E HERNDON AVE SUITE 101
FRESNO CA
93720-3167
US

V. Phone/Fax

Practice location:
  • Phone: 559-434-5639
  • Fax:
Mailing address:
  • Phone: 559-434-5639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA91087
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA91087
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: