1164558706 NPI number — RICHARD L. HOFFMAN, M.D., A PROFESSIONAL CORP

Table of content: (NPI 1164558706)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164558706 NPI number — RICHARD L. HOFFMAN, M.D., A PROFESSIONAL CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICHARD L. HOFFMAN, M.D., A PROFESSIONAL CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1164558706
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/13/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
701 N CRESCENT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEVERLY HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90210-3331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-273-0943
Provider Business Mailing Address Fax Number:
310-273-4359

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 S ALVARADO ST
Provider Second Line Business Practice Location Address:
SUITE 828
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90057-2320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-273-0943
Provider Business Practice Location Address Fax Number:
310-273-4359
Provider Enumeration Date:
02/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HOFFMAN
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
LAWRENCE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
310-273-0943

Provider Taxonomy Codes

  • Taxonomy code: 207RI0011X , with the licence number:  C28338 , 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)

  • Identifier: CT829A . This is a "MEDICARE PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: MEDICARE RAILROAD . This is a "111986055" identifier . This identifiers is of the category "OTHER".




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