Healthcare Provider Details

I. General information

NPI: 1831296516
Provider Name (Legal Business Name): PHILIP HOWARD HOFFMAN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 E COOLEY DR STE 111
COLTON CA
92324-3944
US

IV. Provider business mailing address

1430 E COOLEY DR STE 111
COLTON CA
92324-3944
US

V. Phone/Fax

Practice location:
  • Phone: 909-825-5128
  • Fax: 909-825-8568
Mailing address:
  • Phone: 909-825-5128
  • Fax: 909-825-8568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS 13070
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: