Healthcare Provider Details

I. General information

NPI: 1043969157
Provider Name (Legal Business Name): BRETT HOAG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 03/23/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2332 S BENTLEY AVE APT 301
LOS ANGELES CA
90064-1949
US

IV. Provider business mailing address

2332 S BENTLEY AVE APT 301
LOS ANGELES CA
90064-1949
US

V. Phone/Fax

Practice location:
  • Phone: 949-202-9022
  • Fax:
Mailing address:
  • Phone: 949-202-9022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: