Provider Demographics
NPI:1730578584
Name:WOLFE, GREG (CPED)
Entity type:Individual
Prefix:
First Name:GREG
Middle Name:
Last Name:WOLFE
Suffix:
Gender:M
Credentials:CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 W CENTRAL AVE STE D
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-2200
Mailing Address - Country:US
Mailing Address - Phone:714-990-5932
Mailing Address - Fax:714-990-4060
Practice Address - Street 1:1050 W CENTRAL AVE STE D
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-2200
Practice Address - Country:US
Practice Address - Phone:714-990-5932
Practice Address - Fax:714-990-4060
Is Sole Proprietor?:No
Enumeration Date:2015-01-16
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCCPED2922224L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist