Provider Demographics
NPI:1770663247
Name:WOLFSEN, ADA RUTH (MD)
Entity Type:Individual
Prefix:DR
First Name:ADA
Middle Name:RUTH
Last Name:WOLFSEN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:4077 5TH AVE
Mailing Address - Street 2:DEPARTMENT OF MEDICAL EDUCATION, MER 35
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2105
Mailing Address - Country:US
Mailing Address - Phone:619-686-3444
Mailing Address - Fax:619-260-7305
Practice Address - Street 1:4077 5TH AVE
Practice Address - Street 2:DEPARTMENT OF MEDICAL EDUCATION, MER 35
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2105
Practice Address - Country:US
Practice Address - Phone:619-686-3444
Practice Address - Fax:619-260-7305
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2018-10-31
Deactivation Date:2010-09-27
Deactivation Code:
Reactivation Date:2018-10-31
Provider Licenses
StateLicense IDTaxonomies
CAA23375207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism