Healthcare Provider Details

I. General information

NPI: 1427751759
Provider Name (Legal Business Name): LAURA GRACE WOLFE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2023
Last Update Date: 06/28/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 CHILDRENS WAY # MC5124
SAN DIEGO CA
92123-4223
US

IV. Provider business mailing address

3316 LINCOLN AVE
SAN DIEGO CA
92104-2112
US

V. Phone/Fax

Practice location:
  • Phone: 858-576-1700
  • Fax:
Mailing address:
  • Phone: 858-966-6764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA208825
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: