Healthcare Provider Details

I. General information

NPI: 1669689253
Provider Name (Legal Business Name): CHRISTINA MARIE HOFERER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 E 17TH ST STE 15
COSTA MESA CA
92627-3220
US

IV. Provider business mailing address

24585 JEREMIAH DR
DANA POINT CA
92629-1060
US

V. Phone/Fax

Practice location:
  • Phone: 949-554-4688
  • Fax:
Mailing address:
  • Phone: 949-554-4688
  • Fax: 949-266-8355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number22272
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: