Individual
MR. TIMOTHY J WOLF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
C.R.N.A.08/
Contact information
Practice address
725 S ORANGE AVE, WEST COVINA, CA 91790-2614
(909) 946-5752
(909) 985-3858
Mailing address
220 W 21ST ST, UPLAND, CA 91784-1412
(909) 946-5752
(909) 985-3858
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
NA061
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NA0000610
BLUE SHIELD
CA
05
—
RN1879391
—
CA
Enumeration date
06/28/2006
Last updated
07/08/2007
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