Healthcare Provider Details

I. General information

NPI: 1225597040
Provider Name (Legal Business Name): ERICA BROOKE WOLFISH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32144 AGOURA RD STE 116
WESTLAKE VILLAGE CA
91361-4045
US

IV. Provider business mailing address

32144 AGOURA RD STE 116
WESTLAKE VILLAGE CA
91361-4045
US

V. Phone/Fax

Practice location:
  • Phone: 818-991-1888
  • Fax: 818-991-3888
Mailing address:
  • Phone: 818-991-1888
  • Fax: 818-991-3888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA176329
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: