Healthcare Provider Details

I. General information

NPI: 1871121244
Provider Name (Legal Business Name): MONROE ANITA WOLF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 S GRAND AVE
LOS ANGELES CA
90015-3010
US

IV. Provider business mailing address

2708 WILSHIRE BLVD # 152
SANTA MONICA CA
90403-4706
US

V. Phone/Fax

Practice location:
  • Phone: 213-748-2411
  • Fax:
Mailing address:
  • Phone: 213-748-2411
  • Fax: 310-206-8622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA188330
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: