Provider Demographics
NPI:1760634117
Name:WOLF, NATASHA RAE (ND)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:RAE
Last Name:WOLF
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 GRAND AVE STE E
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-2365
Mailing Address - Country:US
Mailing Address - Phone:760-720-6288
Mailing Address - Fax:760-720-6238
Practice Address - Street 1:640 GRAND AVE STE E
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-2365
Practice Address - Country:US
Practice Address - Phone:760-720-6288
Practice Address - Fax:760-720-6238
Is Sole Proprietor?:No
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND-103175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath