Healthcare Provider Details

I. General information

NPI: 1831692243
Provider Name (Legal Business Name): JOSEPH VERNON HODGKINS (RT)(R)(MR)(ARRT)
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2018
Last Update Date: 03/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 E 7TH ST BLDG 165
LONG BEACH CA
90822-5201
US

IV. Provider business mailing address

48307 80TH ST W
LANCASTER CA
93536-8733
US

V. Phone/Fax

Practice location:
  • Phone: 562-826-8000
  • Fax:
Mailing address:
  • Phone: 661-713-9110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License Number507378
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: