Healthcare Provider Details

I. General information

NPI: 1508847971
Provider Name (Legal Business Name): MELANIE R SPENCER-WOLF DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELANIE R WOLF DO

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 01/06/2023
Certification Date: 01/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 TECHNOLOGY DR
IRVINE CA
92618-2302
US

IV. Provider business mailing address

27700 MEDICAL CENTER RD
MISSION VIEJO CA
92691-6426
US

V. Phone/Fax

Practice location:
  • Phone: 855-206-6764
  • Fax: 949-923-3575
Mailing address:
  • Phone: 949-364-1400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number20A8332
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20A8332
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: