Healthcare Provider Details

I. General information

NPI: 1104270602
Provider Name (Legal Business Name): DIANA HOFFMAN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2016
Last Update Date: 04/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7891 LA TIJERA BLVD
LOS ANGELES CA
90045-3145
US

IV. Provider business mailing address

7891 LA TIJERA BLVD
LOS ANGELES CA
90045-3145
US

V. Phone/Fax

Practice location:
  • Phone: 310-670-1410
  • Fax: 310-670-0919
Mailing address:
  • Phone: 310-670-1410
  • Fax: 310-670-0919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY19281
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: