Healthcare Provider Details

I. General information

NPI: 1902974363
Provider Name (Legal Business Name): MONRO MARK HOFFER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: M. MARK HOFFER M.D.

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 S FLOWER ST OHMG
LOS ANGELES CA
90007-2629
US

IV. Provider business mailing address

2400 S FLOWER ST OHMG
LOS ANGELES CA
90007-2629
US

V. Phone/Fax

Practice location:
  • Phone: 213-742-6527
  • Fax: 213-742-1583
Mailing address:
  • Phone: 213-742-6527
  • Fax: 213-742-1583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberG10463
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: