Provider Demographics
NPI:1750477055
Name:WOLFE, RANDALL ALAN (CRT)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:ALAN
Last Name:WOLFE
Suffix:
Gender:M
Credentials:CRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4303 W AVENUE K8
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-5034
Mailing Address - Country:US
Mailing Address - Phone:661-974-8009
Mailing Address - Fax:
Practice Address - Street 1:44929 10TH ST W
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2313
Practice Address - Country:US
Practice Address - Phone:661-974-8009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARCP-160912278H0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278H0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5787670001Medicare ID - Type Unspecified