Provider Demographics
NPI:1508847971
Name:SPENCER-WOLF, MELANIE R (DO)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:R
Last Name:SPENCER-WOLF
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:MELANIE
Other - Middle Name:R
Other - Last Name:WOLF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:27700 MEDICAL CENTER RD
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6426
Mailing Address - Country:US
Mailing Address - Phone:949-364-1400
Mailing Address - Fax:
Practice Address - Street 1:11 TECHNOLOGY DR
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2302
Practice Address - Country:US
Practice Address - Phone:855-206-6764
Practice Address - Fax:949-923-3575
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8332208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB211821Medicare PIN
CA00AX83320Medicaid
CAI05907Medicare UPIN