Healthcare Provider Details

I. General information

NPI: 1528591591
Provider Name (Legal Business Name): PENTHOUSE PHYSICIANS GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2017
Last Update Date: 04/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8929 WILSHIRE BLVD PENTHOUSE SUITE
BEVERLY HILLS CA
90211-1938
US

IV. Provider business mailing address

8929 WILSHIRE BLVD PENTHOUSE SUITE
BEVERLY HILLS CA
90211-1938
US

V. Phone/Fax

Practice location:
  • Phone: 310-273-5100
  • Fax:
Mailing address:
  • Phone: 310-273-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA74133
License Number StateCA

VIII. Authorized Official

Name: DR. JEFFREY DAVID HOEFFLIN
Title or Position: CEO/PRESIDENT
Credential: M.D.
Phone: 310-998-7792