Healthcare Provider Details

I. General information

NPI: 1477305662
Provider Name (Legal Business Name): ASHLEY HOGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2024
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7730 HERSCHEL AVE STE AA
LA JOLLA CA
92037-4438
US

IV. Provider business mailing address

13708 RUETTE LE PARC UNIT D
DEL MAR CA
92014-3584
US

V. Phone/Fax

Practice location:
  • Phone: 702-420-6368
  • Fax:
Mailing address:
  • Phone: 702-420-6368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225500000X
TaxonomyRespiratory/Developmental/Rehabilitative Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: