Provider Demographics
NPI:1962885764
Name:WOLF, ALEJANDRO J (DO)
Entity type:Individual
Prefix:DR
First Name:ALEJANDRO
Middle Name:J
Last Name:WOLF
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7703 NAVARRO VIEW CT
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-4864
Mailing Address - Country:US
Mailing Address - Phone:825-966-6573
Mailing Address - Fax:
Practice Address - Street 1:305 PARK CREEK DR
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-4426
Practice Address - Country:US
Practice Address - Phone:559-326-2800
Practice Address - Fax:559-326-2801
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12213186-1204207ZP0102X
WA390200000X
390200000X
CA20A22912207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program