Healthcare Provider Details

I. General information

NPI: 1154560035
Provider Name (Legal Business Name): DAVID LINDSEY WOLF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2009
Last Update Date: 02/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9850 GENESEE AVE STE 500
LA JOLLA CA
92037-1213
US

IV. Provider business mailing address

2240 ENCINITAS BLVD STE D50
ENCINITAS CA
92024-4345
US

V. Phone/Fax

Practice location:
  • Phone: 858-450-1776
  • Fax: 858-450-9446
Mailing address:
  • Phone: 858-759-6729
  • Fax: 858-759-6739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberG23881
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: