Provider Demographics
NPI:1386211621
Name:WOLFTECH MEDICAL LLC
Entity Type:Organization
Organization Name:WOLFTECH MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISETTE
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:MONTOYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:754-212-2187
Mailing Address - Street 1:6201 BONHOMME RD STE 370N
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-4427
Mailing Address - Country:US
Mailing Address - Phone:754-212-2187
Mailing Address - Fax:
Practice Address - Street 1:6201 BONHOMME RD STE 370N
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-4427
Practice Address - Country:US
Practice Address - Phone:754-212-2187
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-07
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies