Provider Demographics
NPI:1598704264
Name:WOLFE, GARY ROBERT (PHD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:ROBERT
Last Name:WOLFE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 E TEMPLE ST
Mailing Address - Street 2:DVA LOS ANGELES OUTPATIENT CLINIC
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-3328
Mailing Address - Country:US
Mailing Address - Phone:213-253-5186
Mailing Address - Fax:213-253-5041
Practice Address - Street 1:351 E TEMPLE ST
Practice Address - Street 2:DVA LOS ANGELES OUTPATIENT CLINIC
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-3328
Practice Address - Country:US
Practice Address - Phone:213-253-5186
Practice Address - Fax:213-253-5041
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY4540103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical