Provider Demographics
NPI:1851459663
Name:LISA WOOLF , M.D., A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:LISA WOOLF , M.D., A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:PATTYE
Authorized Official - Middle Name:
Authorized Official - Last Name:OLMACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-879-1935
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69234207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA69234Medicare ID - Type UnspecifiedMEDICARE PROVIDER #