Healthcare Provider Details

I. General information

NPI: 1972540516
Provider Name (Legal Business Name): JOHN HAUSDORFF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 05/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 HARRIS CT BLDG T, 2ND FLR SUITE 201
MONTEREY CA
93940
US

IV. Provider business mailing address

5 HARRIS CT # 201 BLDG T, 2ND FLR
MONTEREY CA
93940-5750
US

V. Phone/Fax

Practice location:
  • Phone: 831-375-4105
  • Fax: 831-372-5722
Mailing address:
  • Phone: 831-375-4105
  • Fax: 831-372-5722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080H0002X
TaxonomyPediatric Hospice and Palliative Medicine Physician
License Number113577
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberG72868
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: