Healthcare Provider Details

I. General information

NPI: 1285970863
Provider Name (Legal Business Name): MICHAEL ELIOT HOFFMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2012
Last Update Date: 12/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18025 BORIS DR
ENCINO CA
91316-4350
US

IV. Provider business mailing address

18025 BORIS DR
ENCINO CA
91316-4350
US

V. Phone/Fax

Practice location:
  • Phone: 877-242-8677
  • Fax: 877-242-8677
Mailing address:
  • Phone: 877-242-8677
  • Fax: 877-242-8677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberG52057
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: