Healthcare Provider Details

I. General information

NPI: 1548893571
Provider Name (Legal Business Name): MR. WILLIAM ROBERT HOFFMAN JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2020
Last Update Date: 02/18/2020
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23701 E EAST FORK RD
AZUSA CA
91702-1477
US

IV. Provider business mailing address

23701 E EAST FORK RD
AZUSA CA
91702-1477
US

V. Phone/Fax

Practice location:
  • Phone: 626-250-3290
  • Fax:
Mailing address:
  • Phone: 626-250-3290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number115951
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: