Healthcare Provider Details

I. General information

NPI: 1245308501
Provider Name (Legal Business Name): MICHAEL WOLFES CLMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2006
Last Update Date: 04/14/2022
Certification Date: 08/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35957 PALOMINO WAY
PALM DESERT CA
92211-2642
US

IV. Provider business mailing address

35957 PALOMINO WAY
PALM DESERT CA
92211-2642
US

V. Phone/Fax

Practice location:
  • Phone: 760-898-9231
  • Fax:
Mailing address:
  • Phone: 760-898-9231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number00000000
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: