Healthcare Provider Details

I. General information

NPI: 1881198695
Provider Name (Legal Business Name): EDWIN CACUNDANGAN HOJILLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 09/22/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 N DOUTY ST
HANFORD CA
93230-3722
US

IV. Provider business mailing address

1025 N DOUTY ST
HANFORD CA
93230-3722
US

V. Phone/Fax

Practice location:
  • Phone: 559-537-0170
  • Fax: 559-537-0196
Mailing address:
  • Phone: 559-537-0170
  • Fax: 559-537-0196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberA175181
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: