Healthcare Provider Details

I. General information

NPI: 1255214722
Provider Name (Legal Business Name): HOFTMAN MENTAL HEALTH SERVICES, PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2025
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 MAIN ST STE A
EL SEGUNDO CA
90245-2570
US

IV. Provider business mailing address

525 MAIN ST STE A
EL SEGUNDO CA
90245-2570
US

V. Phone/Fax

Practice location:
  • Phone: 424-944-8549
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0005X
TaxonomyNeurodevelopmental Disabilities Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: GIL D HOFTMAN
Title or Position: CEO
Credential: MD, PHD
Phone: 424-944-8549