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General NPI Number Information
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NPI Number | 1295096006
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Entity Type | Individual
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Provider Name | STEPHEN WOLF L.AC., M.AC.OM
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Gender | Male
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Dates
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Enumeration Date | 06/07/2012
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Last Update Date | 06/07/2012
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Provider Practice Location Address
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Address Line | 6801 E CAMINO PRINCIPAL STE 101
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City | TUCSON
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State | AZ
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Zip | 85715-3994
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Country | US
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Telephone | 520-977-6466
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Fax |
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Provider Business Mailing Address
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Address Line | 4201 E MONTE VISTA DR APT C-203
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City | TUCSON
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State | AZ
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Zip | 85712-5549
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Country | US
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Telephone | 520-977-6466
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 0797
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License Number State | AZ
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