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NPI Code Detail

MEDICARE: DR. GARY ROBERT WOLFE PH.D.

MEDICARE: DR. GARY ROBERT WOLFE PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical PsychologistPSY4540CA

General Provider Information

NPI Number : 1598704264
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GARY ROBERT WOLFE PH.D.
Provider Business Mailing Address
First Line : 351 E TEMPLE ST
Second Line : DVA LOS ANGELES OUTPATIENT CLINIC
City : LOS ANGELES
State : CA
Zip : 90012-3328
Country : US
Telephone Number : 213-253-5186
Fax Number : 213-253-5041
Provider Business Practice Location Address
First Line : 351 E TEMPLE ST
Second Line : DVA LOS ANGELES OUTPATIENT CLINIC
City : LOS ANGELES
State : CA
Zip : 90012-3328
Country : US
Telephone Number : 213-253-5186
Fax Number : 213-253-5041
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2006
Last Update Date : 07/08/2007

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