Healthcare Provider Details

I. General information

NPI: 1831069533
Provider Name (Legal Business Name): MARIAH WOLFE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2025
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9925 INTERNATIONAL BLVD
OAKLAND CA
94603-2558
US

IV. Provider business mailing address

9925 INTERNATIONAL BLVD
OAKLAND CA
94603-2558
US

V. Phone/Fax

Practice location:
  • Phone: 510-777-1177
  • Fax:
Mailing address:
  • Phone: 510-777-1177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2026021498
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95371135
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: