Individual
FREDERICK WOLFE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
15243 VANOWEN ST, VAN NUYS, CA 91405-3605
(818) 782-6110
Mailing address
PO BOX 190, SIMI VALLEY, CA 93062-0190
(805) 522-5940
(805) 522-6401
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
G18966
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G189660
—
CA
Enumeration date
05/16/2006
Last updated
02/10/2015
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