Healthcare Provider Details

I. General information

NPI: 1831586783
Provider Name (Legal Business Name): MARTIN HOFMANN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2015
Last Update Date: 07/07/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11370 ANDERSON ST STE 1100
LOMA LINDA CA
92354-3450
US

IV. Provider business mailing address

11370 ANDERSON ST STE 1100
LOMA LINDA CA
92354-3450
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-2830
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number35.139233
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberA144764
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: