Healthcare Provider Details

I. General information

NPI: 1235755299
Provider Name (Legal Business Name): HOFMEISTER MEDICAL, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2020
Last Update Date: 06/24/2020
Certification Date: 06/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31735 RIVERSIDE DR STE K
LAKE ELSINORE CA
92530-7816
US

IV. Provider business mailing address

31735 RIVERSIDE DR STE K
LAKE ELSINORE CA
92530-7816
US

V. Phone/Fax

Practice location:
  • Phone: 951-245-2333
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: PATRICK CONNOLLY
Title or Position: EMPLOYEE
Credential:
Phone: 951-245-2333