Healthcare Provider Details

I. General information

NPI: 1548758436
Provider Name (Legal Business Name): PETER LAWRENCE HOFFMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2018
Last Update Date: 04/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2904 ROWENA AVE
LOS ANGELES CA
90039-2042
US

IV. Provider business mailing address

750 N KINGS RD APT 207
LOS ANGELES CA
90069-5905
US

V. Phone/Fax

Practice location:
  • Phone: 424-274-1003
  • Fax:
Mailing address:
  • Phone: 323-574-6204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMFT97173
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: