Provider Demographics
NPI:1386702090
Name:WOOLF, LISA (MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:WOOLF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32144 AGOURA RD
Mailing Address - Street 2:STE 202
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-4048
Mailing Address - Country:US
Mailing Address - Phone:818-991-5551
Mailing Address - Fax:
Practice Address - Street 1:32144 AGOURA RD
Practice Address - Street 2:STE 202
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-4048
Practice Address - Country:US
Practice Address - Phone:818-991-5551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69234207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH04484Medicare UPIN
CAA69234Medicare ID - Type UnspecifiedMEDICARE PROVIDER #