1023468360 NPI number — LESLIE L WOLFF R.N

Table of content: LESLIE L WOLFF R.N (NPI 1023468360)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023468360 NPI number — LESLIE L WOLFF R.N

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOLFF
Provider First Name:
LESLIE
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
R.N
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023468360
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/17/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1075 ROLLINS RD
Provider Second Line Business Mailing Address:
APT 305
Provider Business Mailing Address City Name:
BURLINGAME
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94010-2576
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-287-2534
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2600 S EL CAMINO REAL
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
SAN MATEO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94403-2380
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-373-0777
Provider Business Practice Location Address Fax Number:
650-645-1770
Provider Enumeration Date:
06/17/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  95089516 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)