Provider Demographics
NPI:1215264379
Name:WOLF, LAURENCE E
Entity type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:E
Last Name:WOLF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1603
Mailing Address - Street 2:
Mailing Address - City:ROSS
Mailing Address - State:CA
Mailing Address - Zip Code:94957-1603
Mailing Address - Country:US
Mailing Address - Phone:415-461-1180
Mailing Address - Fax:415-461-1108
Practice Address - Street 1:32 ROSS COMMON
Practice Address - Street 2:SUITE 250
Practice Address - City:ROSS
Practice Address - State:CA
Practice Address - Zip Code:94957
Practice Address - Country:US
Practice Address - Phone:415-461-1180
Practice Address - Fax:415-461-1108
Is Sole Proprietor?:No
Enumeration Date:2009-11-11
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG86721174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist