MEDICARE: MRS. DELLA WOLFSON

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
1	237700000X	Hearing Instrument Specialist	HA 2773	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1369367	OTHER	CA	CMS
2	HA 2773	OTHER	CA	STATE LICENSE

General Provider Information

NPI Number	:	1699815860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DELLA WOLFSON

Provider Business Mailing Address
First Line	:	2353 WESTWOOD BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-2109
Country	:	US
Telephone Number	:	310-475-5023
Fax Number	:	310-475-1164

Provider Business Practice Location Address
First Line	:	2353 WESTWOOD BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-2109
Country	:	US
Telephone Number	:	310-475-5023
Fax Number	:	310-475-1164

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	07/08/2007

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Directions to “ MRS. DELLA WOLFSON ” Practice Location

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