Healthcare Provider Details

I. General information

NPI: 1093873614
Provider Name (Legal Business Name): STUART WOLF MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 06/17/2023
Certification Date: 06/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3621 MLK JR BLVD STE 6
LYNWOOD CA
90262-3512
US

IV. Provider business mailing address

PO BOX 1867
SOUTH GATE CA
90280-1867
US

V. Phone/Fax

Practice location:
  • Phone: 323-566-1675
  • Fax:
Mailing address:
  • Phone: 323-566-1675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. STUART WOLF
Title or Position: PRESIDENT
Credential: MD
Phone: 323-566-1675