MEDICARE: MR. LEROY MARTIN HOFFMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1043483654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LEROY MARTIN HOFFMAN

Provider Business Mailing Address
First Line	:	415 W OCEAN BLVD
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90802-4512
Country	:	US
Telephone Number	:	714-270-6616
Fax Number	:

Provider Business Practice Location Address
First Line	:	415 W OCEAN BLVD
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90802-4512
Country	:	US
Telephone Number	:	714-270-6616
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2008
Last Update Date	:	04/04/2008

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