Healthcare Provider Details

I. General information

NPI: 1134160823
Provider Name (Legal Business Name): DAVID I. WOLF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 12/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3629 VISTA WAY
OCEANSIDE CA
92056-4522
US

IV. Provider business mailing address

3629 VISTA WAY
OCEANSIDE CA
92056-4522
US

V. Phone/Fax

Practice location:
  • Phone: 760-828-9200
  • Fax: 760-828-9141
Mailing address:
  • Phone: 760-828-9201
  • Fax: 760-828-9141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberG48743
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: