Healthcare Provider Details

I. General information

NPI: 1306321518
Provider Name (Legal Business Name): AEROSHIKHA ROSE WOLF MSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2018
Last Update Date: 10/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 3/4 N HOBART BLVD
LOS ANGELES CA
90027-5670
US

IV. Provider business mailing address

1420 3/4 N HOBART BLVD
LOS ANGELES CA
90027-5670
US

V. Phone/Fax

Practice location:
  • Phone: 415-259-7659
  • Fax:
Mailing address:
  • Phone: 415-259-7659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number808560
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WP0218X
TaxonomyPediatric Oncology Registered Nurse
License Number808560
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: