Provider Demographics
NPI:1306076468
Name:WOLFSON MEDICAL CENTER AT TENAYA
Entity type:Organization
Organization Name:WOLFSON MEDICAL CENTER AT TENAYA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLFSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-452-2526
Mailing Address - Street 1:10788 RIVENDELL AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-1803
Mailing Address - Country:US
Mailing Address - Phone:702-363-9900
Mailing Address - Fax:
Practice Address - Street 1:2655 BOX CANYON DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-1119
Practice Address - Country:US
Practice Address - Phone:702-363-9900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-22
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site