Provider Demographics
NPI:1518083690
Name:WOLF, DONNA M (RDN, CLT, IF)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:M
Last Name:WOLF
Suffix:
Gender:F
Credentials:RDN, CLT, IF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4320 MILANO WAY
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92057-7645
Mailing Address - Country:US
Mailing Address - Phone:858-335-2140
Mailing Address - Fax:760-231-6201
Practice Address - Street 1:4320 MILANO WAY
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92057-7645
Practice Address - Country:US
Practice Address - Phone:858-335-2140
Practice Address - Fax:760-231-6201
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA386120133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered