Provider Demographics
NPI:1609041649
Name:LJ WOLFF MEDICAL CORPORATION
Entity Type:Organization
Organization Name:LJ WOLFF MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:WOLFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-451-5603
Mailing Address - Street 1:5301 F STREET
Mailing Address - Street 2:SUITE 111
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-3220
Mailing Address - Country:US
Mailing Address - Phone:916-451-5603
Mailing Address - Fax:916-452-1733
Practice Address - Street 1:5301 F STREET
Practice Address - Street 2:SUITE 111
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-3220
Practice Address - Country:US
Practice Address - Phone:916-451-5603
Practice Address - Fax:916-452-1733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG34846207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOG348460Medicaid
1588613749OtherINDIVIDUAL NPI
1588613749OtherINDIVIDUAL NPI
CAA46113Medicare UPIN