1013458496 NPI number — MS. KAREN JILL HOFFMANN MFT38290

Table of content: MS. KAREN JILL HOFFMANN MFT38290 (NPI 1013458496)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013458496 NPI number — MS. KAREN JILL HOFFMANN MFT38290

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOFFMANN
Provider First Name:
KAREN
Provider Middle Name:
JILL
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MFT38290
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:
1013458496
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 482
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE ELSINORE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92531-0482
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-522-7083
Provider Business Mailing Address Fax Number:
951-223-9020

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
41120 ELM ST
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
MURRIETA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92562-1423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-522-7083
Provider Business Practice Location Address Fax Number:
951-223-9020
Provider Enumeration Date:
03/17/2017

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: 106H00000X , with the licence number:  38290 , 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)





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