Healthcare Provider Details

I. General information

NPI: 1417083155
Provider Name (Legal Business Name): GILLIAN HOFFMAN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8929 UNIVERSITY CENTER LN SUITE 200
SAN DIEGO CA
92122-1006
US

IV. Provider business mailing address

12641 MONTEREY CYPRESS WAY
SAN DIEGO CA
92130-2423
US

V. Phone/Fax

Practice location:
  • Phone: 858-457-3545
  • Fax:
Mailing address:
  • Phone: 858-342-8292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number19979
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: