Healthcare Provider Details

I. General information

NPI: 1609783026
Provider Name (Legal Business Name): ALEXANDER C. WULFF, DO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11710 WILSHIRE BLVD
LOS ANGELES CA
90025-1503
US

IV. Provider business mailing address

11710 WILSHIRE BLVD
LOS ANGELES CA
90025-1503
US

V. Phone/Fax

Practice location:
  • Phone: 310-873-4414
  • Fax:
Mailing address:
  • Phone: 310-873-4414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ALEXANDER C WULFF
Title or Position: CEO
Credential: DO
Phone: 925-963-7861