Provider Demographics
NPI:1821204710
Name:WOLMAN, STUART ALAN (MD)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:ALAN
Last Name:WOLMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1800 FAIRBURN AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5958
Mailing Address - Country:US
Mailing Address - Phone:310-470-4837
Mailing Address - Fax:310-475-6296
Practice Address - Street 1:1800 FAIRBURN AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5958
Practice Address - Country:US
Practice Address - Phone:310-470-4837
Practice Address - Fax:310-475-6296
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG380742084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry