Healthcare Provider Details

I. General information

NPI: 1104905025
Provider Name (Legal Business Name): JILL M. HOFFELLER JILL HOFFELLER M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

872 WELLESLEY AVE
LOS ANGELES CA
90049-5226
US

IV. Provider business mailing address

872 WELLESLEY AVE
LOS ANGELES CA
90049-5226
US

V. Phone/Fax

Practice location:
  • Phone: 310-207-9797
  • Fax:
Mailing address:
  • Phone: 310-207-9797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number5254
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: