Healthcare Provider Details

I. General information

NPI: 1740314764
Provider Name (Legal Business Name): JEFFREY A. WOLF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 PENINSULA CTR #400
ROLLING HILLS ESTATES CA
90274-3506
US

IV. Provider business mailing address

42 PENINSULA CTR #400
ROLLING HILLS ESTATES CA
90274-3506
US

V. Phone/Fax

Practice location:
  • Phone: 714-226-6567
  • Fax:
Mailing address:
  • Phone: 714-226-6567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberG25318
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: