Provider Demographics
NPI:1417140674
Name:WOLF, DANIEL LLOYD (LAC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:LLOYD
Last Name:WOLF
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 FAIRHAVEN AVE APT 5B
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-6772
Mailing Address - Country:US
Mailing Address - Phone:714-612-5048
Mailing Address - Fax:
Practice Address - Street 1:362 W MISSION AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-1740
Practice Address - Country:US
Practice Address - Phone:760-747-3136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 7692171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist