Provider Demographics
NPI:1366571986
Name:WOLMER, JEFFREY (HIS)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:WOLMER
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11830 CYPRESS CANYON RD # 1
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-3735
Mailing Address - Country:US
Mailing Address - Phone:858-455-9531
Mailing Address - Fax:
Practice Address - Street 1:13342 POWAY RD
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-4626
Practice Address - Country:US
Practice Address - Phone:858-391-1224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA5028237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist