Healthcare Provider Details

I. General information

NPI: 1043001050
Provider Name (Legal Business Name): LISA MARGARET HOFFMAN PPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA MARGARET BURKLE PPO

II. Dates (important events)

Enumeration Date: 05/16/2025
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16661 OLD MILL RD
NEVADA CITY CA
95959-8675
US

IV. Provider business mailing address

16661 OLD MILL RD
NEVADA CITY CA
95959-8675
US

V. Phone/Fax

Practice location:
  • Phone: 530-265-9052
  • Fax:
Mailing address:
  • Phone: 530-265-9052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number250014861
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: