Provider Demographics
NPI:1033293394
Name:WOLF, STUART (MD)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:
Last Name:WOLF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:STUART
Other - Middle Name:
Other - Last Name:WOLF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1867
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-1867
Mailing Address - Country:US
Mailing Address - Phone:323-566-1675
Mailing Address - Fax:323-566-0325
Practice Address - Street 1:3621 MLK JR BLVD STE 6
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-3512
Practice Address - Country:US
Practice Address - Phone:323-566-1675
Practice Address - Fax:323-566-0325
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA835960204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A359600Medicaid
CAWA35960CMedicare PIN