Provider Demographics
NPI:1538285770
Name:WOLFF, STEPHANIE MICHEL (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:MICHEL
Last Name:WOLFF
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:1505 WILSON TER
Mailing Address - Street 2:SUITE 250
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-4071
Mailing Address - Country:US
Mailing Address - Phone:818-246-7115
Mailing Address - Fax:818-246-8352
Practice Address - Street 1:1505 WILSON TER
Practice Address - Street 2:SUITE 250
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4071
Practice Address - Country:US
Practice Address - Phone:818-246-7115
Practice Address - Fax:818-246-8352
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20653363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical